MINOR SURGERY; 



HINTS ON THE EVERY-DAY DUTIES 
OF THE SURGEON. 



BY HENRY H. SMITH, M.D., 

Lecturer on Minor Surgery; Fellow of the College of Physicians ; 
Member of the Philadelphia Medical Society, etc. 



KUustrateti ln> lEnflvabinrjs. 



PHILADELPHIA : 

ED. BARRINGTON & GEO. D. HASWELL. 
1 843. 






fg*** 1 ***-*- 



$r* 



[Entered, according to Act of Congress, in the year 1843, by 
Barrington & Has well, in the Clerk's Office of the District 
Court for the Eastern District of Pennsylvania.] 



/■ 



PRE FAC E 



The shortness of the period usually allotted to 
a course of lectures on Surgery, and the rapidity 
with which the lecturer is obliged to pass over 
the methods of Dressing and the Minor Surgical 
Operations, has left a deficit in the amount of 
knowledge required for daily practice, which every 
one commencing has more or less severely felt. 
With a view of filling up this, as well as in com- 
pliance with the repeated requests of several mem- 
bers of his class, the author has been induced to 
undertake the present work, not in the expecta- 
tion of being able to offer any thing new or ori- 
ginal on a subject which has so long engaged 
more or less of the attention of every one, but with 
the hope that he might afford a concise and 
methodical system of Minor Surgery, adapted to 
the wants of the student and young practitioner 
in the United States. 

In doing this, he has drawn freely on the works 
of MM. Velpeau, Gerdy, Mayor, and others, as 






4 PREFACE. 

well as upon many practical details obtained from 
the distinguished Surgeons of the Pennsylvania 
Hospital during a residence under them in that 
institution. 

In order to facilitate the comprehension of many 
of the plans herein proposed, a large number of 
excellent cuts have been furnished by Neville 
Johnson, which,fromtheir accuracy, will frequently 
show at a glance what many lines of text could 
not teach as well. 

Should the volume supply, to any young prac- 
titioner, that practical assistance of which the 
author has himself felt the want, it will have ful- 
filled all that was desired. 

HENRY H. SMITH. 

No. 117 S. Ninth Street. 
August, 1843. 



CONTENTS 



Preface 

Minor Surgery, definition of 



page 

3 

13 



PART FIRST. 



ON THE PREPARATION AND APPLICATION OF DRESSINGS. 



Dressings, preparation and application of 
Instruments of 
Pieces of 

Lint 

Charpie 

Cotton 

Tow . 
Compresses 

Square 

Triangular 

Cribriform 

Maltese Cross 

Retractors 

Perforated 

Graduated 

Pyramidal 
Adhesive strips 

Baynton's use of 
Seton 
Poultices 
Plasters 
Irrigation 
Rules for dressing 



14 
ib. 
15 
ib. 
16 
19 
20 
ib. 
ib. 
21 
ib. 
22 
23 
ib. 
24 
ib. 
25 
27 
32 
ib. 
34 
35 
38 



6 CONTENTS. 

PART SECOND. 

OF THE PREPARATION AND APPLICATION OF THE BANDAGE. 



Bandage, preparation and application of the 



PAGE 

39 



SECTION FIRST. 



OF THE SIMPLE BANDAGE, OR THE ROLLER. 



Roller, Simple . 
Double-headed 
Application of 
Circular 
Oblique 
Spiral 
Uniting 
Dividing 
Compressing 
Expelling . 
Retaining . 
Reverses of . 
Spiral Bandages 
of Chest 

Abdomen 

Penis 

Fingers 

all the Fingers, or Gauntlet 

Demi-Gauntlet 

Upper Extremity 

Lower Extremity 

French 
Crossed, or Figure of 8 Bandages 
of one Eye 

both Eyes . 

Angle of the Jaw 



40 
41 
ib. 
43,47 
44,49 
ib. ib. 
44 
45 
ib. 
ib. 
ib. 
50 
52 
ib. 
53 
54 
ib. 
55 
56 
ib. 
58 
60 
61 
ib. 
62 
ib. 



CONTENTS. 






7 


PAGE 


Crossed, or Figure of 8 Bandage of the Jaw . 64 


Barton's, for the Jaw 




ib. 


Posterior 8 of the Chest 






65 


Front of Chest, or Anterior 8 






67 


Spica of Shoulder . 






68 


Figure of 8 of Neck and Axilla 






69 


Of one Breast 






70 


both Breasts 






72 


Recaniier's, for Tumours of Breast 






74 


Spica of Groin 






75 


both Groins 






76 


Figure of 8 of the Elbow 






78 


Wrist 






79 


Spica of Thumb 






ib. 


Figure of 8 of both Thighs . 






80 


Knee 






81 


Ankle 






ib. 


Spica of Instep 






83 


Knotted 






84 


of Head 






85 


Recurrent . 






86 


of Head 






87 


two Globes 






88 


Amputations 






89 



SECTION SECOND. 

OF THE COMPOSITION AND APPLICATION OF THE COMPOUND 
BANDAGE, OR THE BANDAGE PROPER. 



Bandage, application of Compound 

T. Bandage .... 
of Head . 


90 
91 
92 


Ear .... 


93 


Nose .... 

Chest . 

Abdomen .... 
Triangular T of Groin 
Double T of Pelvis .... 


94 
95 
96 
ib. 
97 



8 CONTENTS. 




PAGE 


Bandage, Double T of Hands . 




98 


T Perforated of Hand . 




99 


Invaginated 


. 


100 


for Wounds of Lip 


, 


ib. 


Thillaye's 


. 


101 


Invaginated of Body 


. 


104 


for Longitudinal Wounds of the Extremities 


ib. 


for Transverse Wounds of the Extremities 


. 106 


Dry Suture 


• 


. 107 


Wry Neck .... 


. 


, 103 


Jorg's Apparatus 


. 


. 109 


Uniting, of Transverse Wounds of Neck 


, 


. no 


Slings .... 


, 


. 112 


Bandage of Galen . 


, 


ib. 


Four-tailed Sling of Head . 


. 


. 113 


Sling of Neck 


, 


. 114 


Jaw 




. H5 


Face 




ib. 


Mask .... 




15, 135 


Sling of Breast . ; 


. . 


117 


Purses or Suspensories 


. , 


118 


of Nose 


, , 


ib. 


Scrotum . 


9 , 


119 


Sheaths .... 


. 


120 


Laced or Buckled Bandages 


. , 


ib. 


for the Knee 


. , 


ib. 


Stocking 


. 


121 


Gaiter . 


» 


ib. 



SECTION THIRD. 



MAYORS HANDKERCHIEF SYSTEM. 



Handkerchief System 
Square Cap of Head 
Fronto-Occipital Triangle 
Occipito-Frontal 
Bi-Temporal 
Oculo-Occipital 
Fronto-Occipito-Labialis Cravat 



122 
131 
132 
133 

ib. 

ib. 
134 



CONTENTS. 


y 


Mayor's Handkerchief System. 


PAGE 


Facial Triangle 


135 


Vertico-Mental Cravat 


ib. 


Occipito-Auricular . 


ib. 


Sternal Handkerchief 


136 


Fronto-Dorsal .... 


137 


Parieto-Axillaris 


ib. 


Cervical Cravat 


138 


Simple Bis-Axillary Cravat 


139 


Compound Bis-Axillary Cravat 


ib. 


Simple Bis-Axillo-Scapulary Cravat 


140 


Compound Bis-Axillo-Scapulary Cravat 


ib. 


Dorso-Bis-Axillaris . - 


142 


Triangular Cap of Breast • • 


ib. 


Sub-Femoral Handkerchief 


143 


Inter-Femoral Handkerchief 


145 


Single Spica Handkerchief 


ib. 


Double Spica Handkerchief 


ib. 


Suspensory or Handkerchief to Scrotum 


146 


Cervico-Brachial Sling . 


ib. 


Ante-Brachial Trough . 


147 


Triangular Cap of Shoulder 


148 


Triangular Cap of Amputations 


149 


Carpo-Olecranien Handkerchiefs 


150 


Flexor of Wrist 


ib. 


Carpo-Dorsal Triangle . 


ib. 


Metatarso-Malleolar Cravat 


151 


Triangular Cap of Heel 


ib. 


Tarso-Pelvien Cravat 


152 


Compound Metatarso-Rotular Cravat 


153 


Tarso-Patella Cravat 


154 


Triangular Cap of Foot 


ib. 


Tibio-Cervical Sling • 


155 


Tibial Cravat . . . 


156 


Barton's Handkerchief 


ib. 


Mayor's Hyponarthecia , 


157 


Ante-Brachial Hyponarthecia 


162 


Hyponarthecia of Lower Extremities 


165 


Mayor's Clinical Frame 


180 



10 



CONTENTS. 



PART THIRD. 

APPARATUS FOR FRACTURES AND DISLOCATIONS. 



SECTION FIRST. 




OP THE TREATMENT OF FRACTURES. 






PAGE 


Fractures, Treatment of 


192 


of Skull . 


197 


Nose .... 


ib. 


Lower Jaw . . 


ib. 


Gibson's Bandage for 


198 


Vertebrae 


199 


Sternum 


200 


Ribs .. 


ib. 


Pelvis 


ib. 


Clavicle 


ib. 


Dessault's Apparatus for 
Boyer's . . . 
Mayor's 
Fox's 


201 
204 
206 
207 


Scapula 

Velpeau's Bandage for 
Neck of Humerus 


210 

ib. 

211 


Boyer's Bandage for 

for Fracture of Shaft of Humeri 


ib. 
is 213 


of the Condyles . 

Physick's Apparatus for > 
Carved Splint 
Forearm . 


215 

ib. 

216 

217 


Lower End of Radius 


218 


Barton's Bandage for 


ib. 


Metacarpal Bones 
Phalanges . 
Olecranon . 


219 

220 

ib. 


Astley Cooper's Apparatus for 
Dessault's . 


ib. 
221 


Hospital 


222 



CONTENTS. 



11 



PAGE 

Fractures, Boyer's Apparatus for, of the Olecranon 223 

Mayor's .... 224 

Gerdy's .... ib. 

of Coronoid Process ... ib. 

Fractures or the Lower Extremity . . 225 

Elevator for Treatment of, . . . 228 

Fracture of Femur .... ib. 

Bell's Inclined Plane .... 229 

Dupuytren's Inclined Plane ... ib. 

Coates's Extending Band . . . 230 

Physick's Gaiter . . . . 232 

Coates's Perineal Band . . . 233 

Junct-Bags ..... 235 

Splint Cloth ..... ib. 

Scultet's Bandage .... 236 

Eighteen-Tailed Bandage . . . 237 

Splints, for Dessault's ... ib. 

Physick's .... 238 

Boyer's . . . . 241 

Hartshorne . . . 243 

Amesbury's . . . 244 

Gibson's Hagerdon . . . 248 

Gibson's Simple-Inclined Plane . . 250 

N. K. Smith's Splints . . . 251 

Fracture of Patella .... 252 

Dessault's Apparatus for . . . 253 

Dorsey's ..... 254 

Mayor's ..... 255 

Gerdy's . . . . ib. 

Amesbury's ..... 256 

Fracture of Leg .... 257 

Hospital Fracture-Box ... ib. 

Barton's Bran Dressing . . . 259 

Starch Apparatus .... 260 

Fractures of Fibula .... 267 

Amesbury's Apparatus for . . ib. 

Dupuytren's Apparatus for Fractures of the Lower 

Extremity of the Fibula . . . 272 

Apparatus for Fracture of the Os Calcis . 273 

Dislocations ..... 275 



12 



CONTENTS. 



PART FOURTH 



OF THE MINOR SURGICAL OPERATIONS. 









PAGE 


Bloodletting ... . 276 


Phlebotomy 




, 277 


Bleeding in the Arm . 




ib. 


Spring Lancet 






. 279 


Thumb Lancet . 






ib. 


Bleeding in the Hand . 






. 281 


Jugular Vein 






ib 


Ankle . 






282 


Arteriotomy 






285 


Local Bleeding 




, 


286 


Leeching 






287 


Cupping . . 






291 


Scarification, or Fly-bites 






293 


Cutaneous Irritations 






ib. 


Frictions 






ib. 


Blistering 






• 294 


Setons ..... 






ib. 


Issues ..... 






297 


Moxa . . . . 






298 


Vaccination .... 






300 


Injections . . . 






301 


Tooth-Drawing 






302 



MINOR SURGERY. 



In the strict acceptation of the term, Minor Sur- 
gery means that portion of surgery proper, which 
treats of the minor surgical operations and the 
employment of such means for the cure of dis- 
eases, as do not require the division of our tissues, 
or, in other words, constitute a capital operation. 
Under this head is, therefore, included the prepara- 
tion and application of Dressings ; the treatment 
of Fractures and Dislocations, and such minor 
operations and duties as every Surgeon is hourly 
called on to perform, and on the proper perform- 
ance of which rests much of his reputation, as 
though apparently simple and too often looked 
upon as matters which any one can attend to, 
yet in reality difficult, and requiring much method 
and ingenuity to adapt the means to the end in 
view. 

In the systematic consideration of the subject, 
four divisions naturally present themselves : — 1st, 
Dressings ; 2d, Bandages ; 3d, Apparatus for 
Fractures and Dislocations ; and 4th, Minor Ope- 
rations. 

2 



14 MINOR SURGERY. 



PART FIRST. 

ON THE PREPARATION AND APPLICATION OF 
DRESSINGS. 

Dressings may be defined to be those portions 
of different substances, which are applied directly 
to operated or injured surfaces, and are designed 
to facilitate the reunion of divided parts, to protect 
them from external injuries, to serve as means for 
the application of different medicaments, and also 
to absorb discharges, protect neighbouring parts, 
and ensure cleanliness. 

The different articles employed and the means 
by which they are applied, are known under the 
one general head of apparatus of Dressing ; and 
consists of two parts, one containing the Instru- 
ments of Dressing, the other the Pieces of Dress- 
ing to be employed. 

The Instruments of Dressing are those which 
are generally found in the assemblage furnished 
by the cutlers, and known under the name of the 
Pocket Case. This contains Dressing or Ring 
Forceps ; Simple Forceps ; Scissors, both straight 
and curved ; Probes and Directors ; Spatulae ; 
Bistouries ; Abscess Lancets ; Porte Caustic ; 
Tenacula ; Straight and Curved Needles ; Liga- 
tures ; and often such others as the taste of the 
cutler or his interests may lead him to select. 
Under the same head should also be included 



MINOR SURGERY. 



15 



Razors, Basins, Sponges ; and all that is re- 
quisite for the preparing of a part for the applica- 
tion of the dressing. 

The Pieces of Dressing are Lint; Charpie ; 
Cotton ; Tow ; Spread Cerate, or other ointment ; 
Compresses ; Malteese Cross ; Shields for Ampu- 
tations; Adhesive Strips; Setons ; Poultices; Plas- 
ters ; and Irrigations. 

Lint is a soft, delicate tissue or mass, prepared 
in two ways; — in one of which the transverse 
threads of soft old linen are drawn out by a ma- 
chine, leaving the longitudinal ones covered by a 
sort of tomentum or cotton-like mass ; the other, 

Fig. l. 




in which the cotton-like surface is produced by 
scraping, with a sharp knife, a similar piece of 
cloth, previously fastened to some firm substance. 



16 



MINOR SURGERY. 



The first is known as the Patent Lint, and may be 
obtained at any apothecaries, as it is now gene- 
rally manufactured ; the second, is the Domestic 
Lint, and may be made at a moment's notice 
where the first is not convenient. They are both 
employed as primary dressings, either spread with 
ointments or alone. 

Charpie is a substance much employed by the 
French surgeons, and worthy of a more general 
application in the United States. It consists of a 
collection of filaments, separated from morsels of 
old linen rag, four or five inches square, of loose 
texture, and well calculated to absorb. It is di- 
vided into two kinds, according to the length and 
fineness of the thread composing it ; that which is 
long and coarse being employed to keep open 
sinuses, fistulse, and as an outer dressing, while 
the softer, finer kind may be placed in immediate 
contact with the part, especially where the surface 
requires stimulation. 

Various names are given to charpie, according 
to the way in which its fibres are arranged, pre- 
viously to its application ; thus there is the Plu~ 
masseau, Bourdonnet, Tente, Meche, Boulette, 
Tampon, and Pelote ; each of 
which have their peculiar advan- 
tages. 

The Plumasseau is a mass of 
charpie, the filaments of which 
are laid parallel to each other, and 
the ends folded under and flat- 
tened between the palms of the 
hands, so as to make a thick mass 
with rounded edges. As thus 



Fig. 2. 




MINOR SURGERY. 



17 




formed, it is usually spread with cerate, and neatly- 
adapted to the parts it is to cover, care being taken 
that it is not so thick as to overload and heat the 
part, nor yet so thin as to become quickly satu- 
rated with the pus. 

The Bourdonnet is a smaller mass 
of charpie, formed by rolling its fibres 
longitudinally between the hands, so 
as to make an oblong mass, which is 
tied firmly in the middle, so that when 
the ends are brought in contact late- 
rally, it may form a sort of cone. It 
serves for absorbing pus in deep-seated 
wounds, where there is a tendency in 
the edges to close, before the bottom 
has filled up. It is also useful in ar- 
resting hemorrhages from deep-seated vessels ; 
pressure being made by forcing the central part 
upon the vessel, while the loose tissue made by 
the ends assists in the formation of the clot. 

The Tente is the name 
given to conical or cylindrical 
masses or plugs of charpie, 
which are like the Bourdon- 
net, except that instead of 
applying a string to its mid- 
dle, it is there doubled on 
itself and the loose ends twisted by the fingers, so 
as to give it a spiral form and make the apex of a 
cone, the base of which is the part where the 
fibres were doubled on themselves. It is em- 
ployed to dilate fistulous canals or openings which 
are too small to allow of the free escape of pus, 
aud answers very well for moderate dilatation, 
2* 




18 



MINOR SURGERY. 



But where parts are rigid, the Sponge Tente, or 
that made by slicing gentian, carrot, or some other 
porous root, answers better. The Sponge Tente 
is prepared by saturating common sponge with 
melted bees-wax, allowing it to cool and harden, 
and then slicing it into small pieces, of such a size 
as will nearly fill the orifice to be dilated. The 
heat of the part melts the wax, the sponge fills 
with the fluids of the part and gradually dilates 
it : after which a new morsel must 
be introduced. 

The Meche is an assemblage of fila- 
ments of charpie, arranged parallel to 
each other and doubled at the centre. 
It is of great use in the treatment of 
fistula, especially fistula in ano. 
When prepared, it is anointed with 
cerate and introduced into the cavity 
on the point of a probe ; as it prevents 
the edges from healing, it causes the 
cavity to fill gradually from below 
upwards. 

Boulettes are little balls of 
different sizes, made by rol- 
ling charpie between the 
hands until it acquires this 
form. They are extremely 
W porous and absorbent, and 
are useful in filling up puru- 
lent cavities, and preventing 
the matter from burrowing. 
When a number of Boulettes are placed toge- 
ther at the bottom of any cavity, either with a 
view of distending it, or of arresting hemorrhage, 
they take the name of Tampon, They are often 






MINOR SURGERY. 19 

used in gonorrhoeal inflammations of the vagina 
and to arrest uterine hemorrhage ; for the latter 
purpose, especially if the hemorrhage follows an 
operation, they are made of the Boletus Igniarius, 
or puff-ball. 

The Pelote is a large boulette, sur- Fig. 7. 
rounded by a piece of soft rag, the 
edges of which are brought together 
and tied firmly. It is occasionally em- 
ployed in the treatment of herniae, 
especially the umbilical hernia of 
children, where, when bound down 
by adhesive strips or a bandage, it answers very 
well the purpose of a truss. It is also useful in 
the compression of large vessels, as in wounds of 
the axillary artery, and also in hemorrhage from 
parts in the neighbourhood of the rectum, being 
there confined under a T bandage. 

Cotton and Tow are substances which are too 
well known to require a description. Both are 
of comparatively limited utility as dressings, their 
places being usually supplied by charpie. Before, 
however, the application of either to surgical pur- 
poses, they should be well picked or carded to free 
them from foreign matters. The chief use of 
cotton is as a dressing for superficial burns, where 
it is useful by protecting them from the air and 
by absorbing the discharges ; thus forming a sort 
of scab under which they readily heal. When 
intended to be thus used, it is especially neces- 
sary to see that it is free even from specks, 
as the fly is exceedingly apt to lay its egg here, 
where it is vivified by the heat of the body, and 
generates maggots, to the great annoyance of the 



20 



MINOR SURGERY. 



patient and the astonishment of all around him, as 
they are unable to account for their appearance, 
and regard it as a fatal sign. 

Tow is employed chiefly as an outer dressing to 
stumps which are discharging freely, as it absorbs 
well. Care is requisite in forming the Plumasseau 
of Tow for this purpose, that it be not too thick and 
heating, as union is often thus prevented. 

Compresses are pieces of linen which are used 
for confining dressings in their proper situations ; 
preserving wounds from external injuries ; equal- 
ising the surface of limbs for the proper adaptation 
of bandages, and also for the compression of soft 
parts. They should be made of some soft sub- 
stance free from hems or darns, and, with one or 
two exceptions, applied over other dressings. 
Where they are intended to be placed directly on 
a wound, they should always be made of soft 
linen. Compresses have received various names 
according to the way in which they are folded or 
the indications to be fulfilled ; thus we have the 
Square, Oblong, Triangular and Cribriform Com- 
press, the Malteese Cross, the Half 
Malteese Cross, the Single and 
Double Split Compress, the Perfor- 
ated, the Graduated, and the Pyra- 
midal Compress. 

The Square compress is that in 
which the substance used has the 
same dimensions in its two prin- 
cipal diameters. If it is twice as 
long as it is broad, and will form a 
square when doubled in its length, 
it forms the Oblong Compress, and 



Fig. 8. 




MINOR SURGERY. 



21 




Fig. 10. 



is useful in surrounding the trunk, or limbs. When 

a square piece of linen is folded so as to unite 

two of itsangles,itformsthe Triangular Compress, 

and is exceedingly useful 

in confining dressings to 

stumps, when it is desirable 

to remove the dressing often 

without deranging the limb. 

To apply it for this purpose, 

cut one of such a size as will 

surround the limb, place the 

stump in the centre of the 

side a b ; then turn up the apex c, and after 

wards the points a and b. 

The Cribriform Compress 
is a square piece of linen 
pierced with a number of 
holes, and intended when 
spread with cerate to be ap- 
plied directly to a suppu- 
rating surface ; the pus 
passing out through the 
holes allows the compress 
to remain constantly in con- 
tact with the surface, and 
thus prevents the wound 

from being constantly bathed in pus. It also 
assists in the removal of other dressings, by pre- 
venting them from sticking to the part. It is 
formed by folding linen four or six times on it- 
self, so as to form several oblong squares, one 
within the other, and then nicking the sides in 
several points with the scissors, so as to remove 



l ii i i 



22 



MTNOlt SURGERY. 



Fig. 11. 



small pieces ; on opening it, we have the form 

desired. 

The Malteese Cross, so named 
from its shape, is formed from the 
common square compress by folding 
it into an oblong square, doubling 
this in its length to form a smaller 
square — joining two of the angles 
to form a triangle, as in the figure; 
and folding this equilaterally to form 
a smaller triangle, then mark a line 
on its hypothenuse half an inch from 
its apex, and slit the sides down to 
this line, which is dotted in the 
figure. On opening it out we have 

a very regular cross, with a space in the centre, 

which is to cover the 




Fig. 12. 




Fig. 13. 





front of the stump. 
The cross is of great 
use as a primary or 
secondary dressing to 
stumps, as by means of 
the slits it will fold over 
and fit the part very 
accurately. 

The Half Malteese 
Cross is formed by 
slitting the two angles 
of the loose side of an 
oblong square to within 
an inch or two of their 
centre, as seen in the 
figure, and serves a bet- 
ter purpose than the 



MINOR SURGERY. 

full cross, in some cases, as 
in stumps at the shoulder, or 
after amputation at the hip- 
joint, &c. 

The Single Split Compress is 
an oblong piece of muslin split 
as represented in the cut, and in- 
tended to be used as a shield or 
retractor in amputations of the 
arm or thigh. The tails are 
passed on each side of the bone, 
and drawn downwards while the 
upper part is turned upwards 
over the stump, so as to draw the 
muscles back and protect them 
from the action of the saw. The 
diamond shape opening at the 
end of the split is intended to 
adapt it more accurately to the 
bone itself. 

The Double Split Compress, or 
retractor of three tails, differs 
from the preceding one only in 
its being split into three tails in- 
stead of two. It is employed 
with the same view after ampu- 
tations of the forearm and leg ; 
the third tail being pushed through 
the interosseous space, protects 
more thoroughly both the bones 
of the part. 

The Perforated Compress (Fig. 
16) is the name given to a piece 
of muslin folded several times on * 



23 



Fig. 14. 



O 



Fig. 15. 




24 



MINOR SURGERY. 




Fig. 16. itself so as to make a thick mass, in the 
centre of which an opening is made. 
It may be employed to relieve points of 
pressure, especially where they have a 
tendency to slough, as on the internal 
condyle in fractures of the arm, and on 
the heel in fractures of the lower ex- 
tremity ; the sore point being placed in 
the centre of the opening, so as to save 
it, whilst the pressure is borne by the parts on its 
circumference. 

Graduated Compresses are named from their 
construction, and are of several kinds, the sub- 
stance of each being folded differently according 
to the object in view. 

The Common Graduat- 
ed Compress is formed by 
folding a piece of muslin 
several times on itself, so 
that each fold may not 
entirely cover the one that 
has preceded it. It may 
be graduated from one end, or from the circum- 
ference to the centre, as 
Fig. 18. seen in Figures 17, 18. 

The Pyramidal Com- 
press is one that is most 
accurately formed by 
placing on one another, 
square pieces of muslin 
gradually decreasing in size so as to form a pyra- 
mid (Fig. 19) ; or by folding a piece of 2\ inch 
bandage on itself, so as to form a compress gra- 
duated from end to end, and then placing a piece 



Fig. 17. 




MINOR SURGERY. 



25 



Fig. 19. 



of cork or other body in the 
centre of the last turns. 
Thus formed, it is very use- 
ful in making pressure upon 
certain points, as in cases of 
hemorrhage from deep seat- 
ed vessels. 

Adhesive Strips are pieces 
of linen spread with some 
adhesive plaster, usually 
diachylon, and intended to 
promote the union of divided parts. They may 




Fig;. 20. 




26 



MINOR SURGERY. 



be prepared from the sheet on which it is usually 
spread, by sliding the scissors according to the line 
of the thread of the cloth and slitting it into 
pieces about three-quarters of an inchin width (Fig. 
20),andofalengthsufficienttoenableittoextendat 
least three inches beyond each side of the wound, 
which is to be united. Before applying them, it is 
generally necessary to soften the plaster by heat ; and 
the most convenient method of so doing is to fill a 
bottle with boiling water and wrap the strip around 
it, the outside of the strip being next the surface 
of the bottle. In applying it, the strip should be 
first placed on the portion of the wounded surface 
that is most depending, so as to draw it up to the 
other, the intervals between the straps being such 
as to allow of the free escape of the matter. For 
removing them, they should be softened by wash- 
ing the part with warm water, or by applying a 
warm poultice to it a few hours before the dress- 
ing is removed. The surgeon then lays hold of one 
of the extremities of each piece in succession, and 



Fig. 21. 




MINOR SURGERY. 27 

gently raising it, reflects it upon the wound. This 
extremity being detached to within half an inch 
of the edges, he detaches the other to about the 
same distance, and holding them together, lifts them 
perpendicularly, taking care at the same time to 
apply the thumb and index finger of the left hand 
upon the sides of the wound, to prevent injury 
being done to the cicatrix. (Fig. 21.) 

As adhesive strips sometimes irritate and in- 
flame the part, owing to their tearing out the small 
hairs or down which cover it, their application is 
frequently followed by erysipelas. In this case 
their places may be very well supplied by the slit 
and tail, or uniting bandage hereafter mentioned. 
Adhesive strips are also very useful as a dressing 
to ulcers, or for compression in cases of Orchitis 
or Hernia Humoralis. 

As the treatment of ulcers by the use of adhesive 
strips is of considerable importance, a detailed ac- 
count of Baynton's plan is here given. 

Several strips of adhesive plaster, the manner of 
preparing which has been already described of 
about two inches in breadth, and sufficiently long 
to pass round the limb and leave an end of about 
four or five inches ; several longitudinal com- 
presses made of soft calico, and a calico roller 
about three inches in breadth, and varying from 
four to six yards in length, according to the size of 
the limb, are first prepared. Then one of these 
strips is to be applied to the sound side of the 
limb, opposite the inferior part of the ulcer, so that 
the lower edge may be placed about an inch be- 
low the lower edge of the sore, and the ends 
drawn over the lower part of the ulcer, with as 



28 MINOR SURGERY. 

much gradual extension as the patient can con- 
veniently bear ; the other strips are then applied 
in the same manner, each above and in contact 
with the other, until the whole surface of the sore 
and of the limb is covered from one inch below to 
two or three inches above the affected part. 

Fig. 22. 




The whole of the leg, if it is the part affected, 
should then be covered equally with the longi- 
tudinal compresses, and the roller applied round 
the limb, from the toes to the knee, with as much 
firmness as the patient can support without com- 
plaint. One or two spiral turns of the roller should 
be first passed round the ankle-joint, then as many 
round the foot as will cover and support every 
part of it, except the toes, and the same continued 
up the limb as far as the knee ; the roller should 
be carried from the ankle upwards in reverses, as 
many of them being made as the parts require, in 
order that each turn may lie flatly on the limb. 
Should the parts be much inflamed, or the suppu- 
ration very abundant, the applications are to be 
wetted frequently with cold spring-water. The 
patient may take exercise if he pleases, as this will 
be found to alleviate the pain and tend to accele- 
rate the cure. The bandage ought to be daily ap- 



MINOR SURGERY. 29 

plied soon after rising in the morning, when the 
parts are most free from tumefaction ; and the force 
with which the ends of the plasters are drawn over 
the limb gradually increased as the parts return 
to their natural state of ease and sensibility. When 
the cure is thus far accomplished, the roller should 
be applied with as much tightness as the patient 
will bear, more particularly if the limb be in that 
enlarged or compressible state denominated scor- 
butic, or if the edges of the wound be thickened. 

We may remark, that this bandage is liable to 
produce excoriations of the limb, but these are 
never serious except when they occur over the 
Tendo-Achillis. To prevent them or accelerate 
their disappearance, Mr. Baynton recommends the 
application of a small shred of soft leather under 
the adhesive plaster : or a bit of sheet-lead may 
be used in place of the shred of leather, as it 
answers better. 

During the years 1S30 and 1S31, several of the 
most eminent surgeons of Paris submitted Bayn- 
ton's method of compression to a series of experi- 
ments, which, as the result will show, were highly 
favourable to it. Velpeau found the average time 
of cure ten, fifteen, or twenty days, for ulcers of 
three, four, or five inches in circumference. Ph. 
Boyer, who perhaps pushed the experiments fur- 
ther than any one else, found the average period 
of treatment, calculated upon a large number of 
cases, to be twenty-six days ; and this result is so 
much the more striking, as Duchatelet was noticing 
at the same period the average length of time re- 
quired by the older methods, which he found in 
six hundred and ninety cases to be fifty-two days 
3* 



30 MINOR SURGERY. 

and a half, giving a difference of more than half 
in favour of Baynton's plan. In the course of 
these experiments some modifications were intro- 
duced ; as, for instance, that by Velpeau and Ph. 
Boyer,of the substitution of good diachylon plaster 
for the mixture of Baynton. So, with respect to 
the breadth of the plasters, the above surgeons 
found them more advantageous when only an inch 
or an inch and quarter broad. In the course of 
the experiments, Roux and Ph. Boyer found that 
the inflammatory state of the ulcer did not counter- 
indicate the employment of compression, which 
often arrested, even, its secondary effects. Mar- 
jolin, however, recommended the reducing of the 
inflammation before proceeding to compression. 
Velpeau and Roux extended the compressive 
treatment to contused wounds with disorganisation 
of the skin, which were getting into an atonic 
state, and also, to every species of wounds witli or 
without loss of substance when the cicatrization 
was slow, or otherwise checked by a general vice 
of the constitution, attending, however, in the lat^ 
ter case to internal remedial agents calculated to 
benefit the system. Ph. Boyer endeavoured to 
cure syphilitic and scorbutic ulcers by compressive 
strips alone, but without success ; while, by ex- 
erting this species of compression, and employing, 
at the same time, the ordinary internal remedies, 
the cure was remarkably hastened. 

Ph. Boyer's observations all tend to support the 
opinion of Baynton himself, that, when the leg is 
properly bandaged, walking, at least moderately, 
tends to facilitate the cure, and renders it more 
complete. With regard to the periods of renewing 



MINOR SURGERY. 



31 



the bandage, Velpeau found it quite sufficient to 
change it every three, four, or five days, according 
to the degree of irritation. Boyer never dressed 
them oftener than once in forty-eight hours. Val- 
brune considered it necessary to renew the ban- 
dage oftener if the cessation of swelling caused it 
to become relaxed, but agrees with Velpeau and 
Boyer in thinking that the less often the bandage 
is disturbed the better. 

It may perhaps be useful to the young surgeon 
to say that the use of adhesive strips to suppurat- 
ing surfaces often produces a marked blackness of 
the skin. This is nothing but a chemical change 
produced in the plaster by the action of the dis- 
charges, and not the forerunner of gangrene as 
many have at first supposed. Nothing answers 
so well for a compressive bandage of the testicle 
in cases of Epididymitis, or 
chronic enlargement of the 
testicle, as strips of adhesive 
plaster. In order to apply them 
in this case, the swelled testicle 
should be forced to the bottom 
of the scrotum, by surrounding 
the cord with the thumb and 
fingers of one hand so as to 
form a ring, while with the 
oth^r, or with the hand of an 
assistant, the strips are so ap- 
plied as to surround the part 
entirely as seen in Fig. 23. 
These strips should be of the 
width of the thumb, and ap- 
plied over one another from 



Firr. 23. 



-/^ 



^JiF 




32 MINOR SURGERY. 

below upwards, till the testis and a part of the 
eord are compressed between them. Previous to 
their application the parts should be cleansed and 
well shaved ; and the strips should be renewed as 
often as they become slack from the abatement of 
the swelling in the testicle. 

The Seton is a narrow strip of so^ft linen rag, of 
one, or one and a half inches in width, with a few 
of its longitudinal threads drawn out from each 
side, so as to leave a rough or jagged border, and 
intended to keep up irritation and suppuration in a 

part, and thus act as a 
revulsive from other 
parts, A skein of silk, 
a piece of silk braid, 
or, what is still better, 
on account of its clean- 
liness, a strip of gum- 
elastic, may be substi- 
tuted. The introduc- 
tion and dressing of 
the seton will be treated of hereafter. 

Poultices or Cataplasms are different kinds of 
pulp or pastes intended to cover injured surfaces, 
and are made of various substances, according as 
the object is to have an emollient, an astringent, 
or a stimulating one. 

The Emollient Poultice may be made of any 
mild, unirritating substance, as bread and milk 3 
bread and water ; bran and water ; and ground 
flaxseed or flaxseed meal. The latter forms de-? 
cidedly the best poultice, not only as regards its 
properties, but also its economy. It may be pre- 
pared by simply pouring hot water on the meah 




MINOR SURGERY. 



33 



Fig. 25. 



and stirring it till it acquires such a consistence as 
will prevent its running from its softness, or its 
drying and breaking off from the reverse. In order 
to make it, a portion of the paste is dropped on a 
suitable piece of muslin, and spread of an even 
thickness, say about one-fourth or half an inch, 
the free ends of the muslin being folded over so 
as to form a sort of frame or border, and thus pre- 
vents the adhesion of the 
edges (Fig. 25). If the meal 
is not fresh, it will be neces- 
sary to rub a little sweet oil 
over the surface of the 
poultice, or to cover it with 
a piece of fine gauze pre- 
viously softened In warm 
water, to remove its starch, 
and prevent the adhesion 
of the poultice (Fig. 26). 

This, and every other one, should be renewed 




Fig. 26. 



at least twice in twenty- 
four hours, or more fre- 
quently if it becomes hard 
and dry. Care must also 
be taken that the poultice 
has not fermented, or the 
oil, if used, become rancid, 
as it will then irritate in- 
stead of soothing the part. 
The bread and milk, or 
bread and water poultice, is prepared by breaking 
the crumb of bread into either of these liquids till 
they have the proper consistence, when they may 
be spread and used like the first one. 




34 MINOR SURGERY. 

The astringent poultice is formed of the above 
by adding some astringent article. Frequently it 
consists of bread and lead-water, or of a curd 
made by throwing alum into boiling milk, or rub- 
bing it up with the white of egg. These latter 
should always be covered with gauze, as they are 
chiefly used in the treatment of affections of the 
eye. 

The Stimulating Poultice is formed of various 
substances, as, boiled carrot, grated down to a 
pulp ; raw potato, grated and applied cold ; grated 
onions ; Indian meal and some fermenting liquor, 
as yeast or porter ; or flowers of mustard. " The 
Fermenting Poultice, or that made of Indian or 
corn-meal and porter, should always be spread on 
or covered with oiled silk, to prevent its evapora- 
tion and too rapid drying ; and it should, likewise, 
be covered by the gauze to prevent its adhesion. 
It is of great use in cases of sloughing, mortifica-? 
tion, hospital gangrene, &c. 

The Mustard Poultice is prepared by mixing 
flowers of mustard with water to the consistence 
of that which is commonly employed for the table, 
and then spreading it very thinly on muslin, and 
only allowing it to remain on the part till it red- 
dens it — be it five or be it fifteen minutes. The 
vinegar with which it is sometimes mixed, so far 
from increasing its powers of stimulation, mate- 
rially weakens them. 

To confine a poultice to a part, some of the 
bandages hereafter mentioned may be employed 
at the option of the surgeon. 

Plasters are made of various substances, and 
are occasionally employed to soften indolent tu« 



MINOR SURGERY. 



35 



mours, procure their resolution, or hasten their 
suppuratiQn. In their preparation, the surgeon 
has no part, as this properly belongs to the apo- 
thecary. He may, however, be required to direct 
the shape of it, in order to ensure its more accurate 
application. In general, nothing is necessary but 
to slit the angles which project when the plaster 
is applied to the surface ; but in the plaster for the 
female mammae, a peculiar shape is required 
which may be best obtained thus : — Fold a piece 
of paper on itself so as to form a perfect 
square of the size required ; fold this so 
as to make an oblong square ; double it 
and fold its angles so as to make a 
smaller square ; fold this into a triangle, 
and round off its upper angles as in the 
dotted line (Fig. 27). Then cut off semi- 
circularly as much at the point as will 
make an opening large enough to ad- 
mit the nipple, or more if desired ; and 
sides at the circumference for one inch 
the centre. This when opened out will give the 
figure required (as in Fig. 
2S),and will enable any one 
to prepare a plaster of a 
proper shape. 

Irrigation , or dressing 
by imbibition, is the term 
applied to certain dressings 
which are intended to keep 
the parts constantly cool and 
moist by the use of cold 
fluids, and thus diminish an excess of inflamma- 




slit the 
towards 



Fig. 28. 




S6 MINOR SURGERY. 

tion. In simple erysipelas of some extent, in 
phlegmonous erysipelas, in compound fractures, 
in sprains, dislocations, and other injuries to joints, 
and in cases of sloughing from excessive action 
after amputations, they afford us a most excellent 
means of combating the inflammatory action. 
In order, however, that they may be properly ap- 
plied, considerable care and attention is requisite 
on the part of the attendant, for if the stream of 
the liquid is not kept up steadily, there will be a 
constant change in the temperature of the part, 
and a reaction from cold to hot, which must do 
harm ; or there may be too great a degree of cold ; 
or the patient may become wet with the dressing 
and suffer from cold in some internal organ. The 
surgeon, therefore, must be particular in the ar- 
rangement of the apparatus, in the selection of 
the case, that it be dependent on an excess of 
action in the part, in the length of time during 
which it is continued, and in the proper attention 
of the assistant. The simplest form in which it 
can be properly arranged, is that shown in the 
cut (Figure 29, A B B). 

The part to which it is to be applied, is first laid 
upon a piece of oil cloth or coach-curtain, to pre- 
vent the wetting of the bed and clothes of the 
patient, and this is to be bent on the outer side so 
as to form a little gutter to carry off the water, 
after it has gone on the limb, into the vessel placed 
below. A vessel filled either with cold water, 
cold lead- water, or other cold lotion, is placed near 
the bed at such a height as will be most conve- 
nient, and from it strips of patent lint twisted to- 



MINOR SURGERY. 



37 



gether ; or, what is better, a piece of cotton-wick, 
as A and B, extend to a piece of lint which covers 
the part affected, and absorbs the liquid brought 
over. The wick, previous to its application, should 
be so wet as to absorb readily the fluid in the 
basin, or, in other words, form a syphon. 




Another mode of applying irrigation is by means 
of a tube with a cock, arranged as in the same 
cut at C, and which may be made at a moment's 
notice, of a piece of cane-angle and some quills. 

If the patient complains of the cold, it is easy, by 



38 MINOR SURGERY. 

means of the cock, to regulate the amount of fluid 
which shall pass over ; and this is the only advan- 
tage which it possesses over the syphon, while the 
simplicity of the latter, and the facility with which 
it may be made and applied,recommend it strongly 
to our favour. 

Should it be desirable to foment the part, it is 
only necessary to change the liquids, though the 
application of warmth can be better made by 
wringing flannels out of hot water and constantly 
changing them. 

RULES FOR DRESSING. 

The observance of the following rules for the 
application of Dressings will be found to assist us 
materially in the proper use of them. 

1st. Make, or see made, all that is requisite 
for the new dressing before removing the old one. 

2d. Have a sufficient number of aids, to whom 
special duties shall be assigned before commencing 
the dressing, as this prevents confusion ; thus, in 
dressing a stump, there should be one to support 
the limb ; another to furnish hot water, and change 
it as required ; heat the adhesive strips, hand 
cerate, &c, &c, &c, by which means the surgeon 
can give his attention wholly to his own duty. 

3d. Arrange the bed, as a general rule, after the 
dressings are changed ; or, if in a case of fracture, 
before the patient is placed on it. 

4th. Let the position of the patient be such as 
will be as easy for him as possible, so as to cause 
him no unnecessary fatigue, and let the surgeon 
place himself on the outside of the limb, as this 
gives him more freedom in his movements, 



MINOR SURGERY. 39 

5th. Guard against all hasty and inconsiderate 
movements on the part of the assistants or of your- 
self, in order to prevent unnecessary pain to the 
patient. 

6th. If an operation is to be performed, let each 
assistant understand, before you begin, that he is 
to confine himself solely to his own duties; thus, 
one may hand instruments to the operator, an- 
other sponge away blood, &c, &c.,so that when a 
tenaculum or other instrument is wanted, there 
may not be half-a-dozen hands snatching for it, 
to the great risk of all parties. 



PART SECOND. 

OF THE PREPARATION AND APPLICATION OF THE 
BANDA-GE. 

By Bandaging is generally understood the con- 
finement, in their proper situation, of dressings and 
other surgical apparatus, or the retaining in their 
natural position of parts of the body which have 
been previously displaced, and is generally effected 
by means of pieces of muslin or other substance, 
or by mechanical contrivances. The term Ban- 
dage, in its strict signification, is only applicable to 
a collection of bands, or to those pieces of stuff 
which are fastened to one another and employed 
as a whole, though general usage now justifies 
its application to the single Band or Roller. 
This is a strip of flannel, linen, muslin, calico, 



40 



MINOR SURGERY. 



cloth, gum-elastic, or other substance ; and of dif- 
ferent lengths and widths according to the object 
to be attained in its application. As most gene- 
rally found, it consists of a strip of muslin, eight 
or ten yards long, one-half, two, two and a half, 
three, or four inches in width ; free from hems or 
darns, soft, pliable and unglazed to prevent its 
slipping. As thus made, bandages are divided 
into two kinds ; — simple, or those formed by the 
application of the roller only ; and compound, or 
those resulting from the complex arrangement 
of the pieces composing them, as in the double T 
bandage, &c. 



SECTION FIRST. 

OF THE SrMPLE BANDAGE, OR THE ROLLER. 

The simple roller is prepared from a piece of 
muslin of the requisite length and width, by tear- 
ing it from the piece and then winding it into a 
cylindrical form, either by the machine or by the 
hand, so as to form one or two heads, and consti- 
tute what is called the Single or Double-headed 
Roller. The machine for rolling them, one of Dr. 
Barton's earliest contributions to Surgery, is seen 

in Figure 30, and 



Fig. 30. 




consists of a base 
A, and of two up- 
rights, B B, in 
which runs a spin- 
dle, G, to receive 
the bandage ; a 
broader upright, C, 
to support a move- 



MINOR SURGERY. 



41 



able frame, F, which, by its pressure, tends to 
tighter; the bandage, D D, as it is rolled, and 
of a screw, E, to fasten the machine to a table. 
In order to roll the bandage on this, one extre- 
mity of it should be attached to the spindle by 
wrapping it round it, and the rest wound up by 
turning the handle with one hand, while the 
other directs the course of the band and en- 
sures its being wound even ; then tear off all the 
loose threads, as they will not unravel too much 
if the cylinder is tightly rolled, but will run to 
waste if it is loose. Thus formed, the Single- 
headed Roller consists of a cylinder with two extre- 
mities ; of an initial or free 
end, of a terminal one, or that 
found in the centre of the cylin- 
der, of two surfaces ; an exter- 
nal and an internal, and of a 
body, or portion between the 
two ends. 

The Double-headed Boiler has the 
except the initial end, which is 




same parts 




wanting, both ends being here 
wrapped into cylinders ; this 
roller, therefore, always com- 
mences in its application with 
the body or portion between 
the two heads. 

The necessity which exists for the reapplication 
of the same roller, both from economy and conve- 
nience, sometimes compels us to prepare it without 
the aid of the machine, because, unless a roller is 
formed into a cylinder, it will be found impossible 
to apply it properly. In order, therefore, to do 



43 MINOR SURGERY. 

this with the greatest ease, fold the terminal end 
of the roller five or six times on itself, so as to 
form a sort of axis or mass ; roll this a few times 
on the thigh to give it size. Then place its two 
extremities between the thumb and forefinger 
of the right hand, while the body is allowed to 
run over the forefinger of the left, where it should 
be firmly pressed by the thumb of the same hand, 
so as to make a considerable degree of traction, 
and tighten the cylinder. Having arranged this, 
give a rotatory motion to the band, by causing the 
cylinder to revolve upon its axis by means of the 
fingers and thumb of the right hand, whilst, at the 
same time, the left revolves partially around the 
cylinder itself, which, by this compound move- 
ment, is soon formed as required, and as may be 
well seen in the cut. 

Fig. 33. 




After a very little practice, it will be found an 
easy matter thus to roll a bandage with either 



MINOR SURGERY. 43 

hand; almost as quickly and tightly as can be done 
on the machine. 

If the roller is intended for the body, it should 
be twelve yards long and about four inches wide ; 
if for the head, five yards long by two inches 
wide ; if for the extremities, eight yards in length 
and two, two and a half, or three inches in width, 
according to the size of the limb, the thigh requir- 
ing one a little wider than that for the leg. 

In order to apply this single-headed roller, which 
is the one most generally employed, it should be 
held between the thumb and fingers of the right 
hand, and the cylinder pressed by the fingers 
against the palm, to prevent its slipping out of the 
hand as it unrols, which it is apt to do if held ; so 
that its internal surface should be the part first 
applied to the body. Or it may be held by plac- 
ing the thumb and first and second fingers of the 
right hand on the two extremities of the cylinder. 
In either case the external surface of the initial 
end should be the portion first applied to the part, 
and should be retained there by the fingers of the 
left hand until one or two turns are made round 
it so as to fix it firmly, after which we may pro- 
ceed upwards. Bandages have been divided into 
several kinds, from the direction which they take 
in covering a part, or the object to be attained by 
their application ; thus, we have the Circular, the 
Oblique, the Spiral, the figure of 8, the Spica, the 
Recurrent ; and we have also the Uniting, Dividing, 
Compressing, Expulsive, Retaining, &c, including 
those of both the Simple and Compound Ban- 
dages. 

The Circular is that formed by horizontal turns 



44 MINOR SURGERY. 

of the roller, each of which overlaps, or very near- 
ly overlaps, the one which preceded it. 

In the Oblique, the turns gradually ascend the 
limb or pass obliquely to its axis. 

The Spiral mounts still more ;— the Spica forms 
a figure like the leaves of corn ; and in the Recur- 
rent the folds run back to the point whence they 
started. 

The Uniting Bandage, named from its action, 
is that which is used in incised wounds ; it should 
be adapted to their direction according as they 
take a longitudinal or transverse course more or 
less cpmplete : for longitudinal wounds it is con- 
structed with a double-headed roller, the breadth 
of which ought to correspond to the length of the 
wound : a longitudinal slit being made in the 
bqdy, in order to jallow i\\e surgeon, when apply- 
ing the bandage, to pass through it one head 
of the roller, and thus bring together the edges of 
the wound ; this bandage often takes the form of a 
spica. Or it may be made for such woiinds with 
a single-headed roller, by dividing it at one end to 
a convenient distance into three tails, and making 
a little , *yay beyond the termination of these, three 
longitudinal openings to receive them. The unitr 
jng bapdage for transverse wounds consists of two 
strong linen bands of the width of the wound, and 
as long as the member ; one of these is to be split 
about half its length into two or three tails or ban- 
delets, and the other perforated in the middle with 
three corresponding longitudinal openings, as will 
be seen in the consideration of these bandages here? 
after. 



MINOR SURGERY. 45 

The Dividing Bandage is that which is used to 
prevent the formation of seams or unsightly cica- 
trices in the treatment of burns, and of wounds 
attended with great loss of substance. 

The Compressing Bandage is that employed 
for exerting compression in sprains, oedematous 
swellings, callous ulcers, varices, aneurisms, erec- 
tile tumours, &c. 

The Expelling Bandage is employed in the 
treatment of ulcers, deep-seated abscesses.contused 
wounds, &c. It is composed of a roller applied 
over graduated compresses, upon the region where- 
in the pus or blood is lodged, to which it is desired 
to give issue : it prevents these fluids from insinu- 
ating themselves along the interstices of the mus- 
cles, and detaching the skin from its adherence to 
the subjacent parts, or forming sinuses. 

Retaining Bandages are those which serve to 
confine dressings and displaced parts ib their pro- 
per situation. Into this class enter herniary ban- 
dages, and those for fractures and dislocations. 

A bandage which does not give the most perfect 
support to the parts, maintain them in the position 
necessary to ensure the fulfilment of the indica- 
tion proposed, and exert on the member an equable 
compression, is useless, or worse than useless, as 
it may produce such a state of things as may even- 
tuate in the loss of the limb or even of life. When, 
therefore, it is applied too tight, or when the com- 
pression is not uniform, very serious consequences 
may arise, such as oedematous swellings, and even 
mortification : their proper application is, there- 
fore, a matter of great importance. 

In the department of surgery which constitutes 



46 MINOR SURGERY. 

the subject of this part of the work more perhaps 
than in any other, is the practitioner's reputation 
exposed to the severity of criticism ; and on the 
degree of knowledge and dexterity which he 
evinces in this, as attested by the greater or less 
acuteness of the patient's sufferings, the duration 
of the treatment, and the issue of the case, will be 
found to depend the favourable or unfavourable 
general opinion of his talents : the majority of peo- 
ple can usually well appreciate what is palpable to 
the senses in the practice of the healing art, and 
therefore it is not surprising that they here exer- 
cise their privilege of criticism to its utmost limits. 
Those who, from syant of practice, cannot pro- 
duce the neat appearance of a well applied ban- 
dage, and thus escape the remarks oftep made in 
regard to it by those around the patient, are fre- 
quently induced, in order to effect it, Jo resort to 
the wetting of the roller, as it then adapts itself 
much more readily to the part. But this should 
never be done except in the treatment of Disloca- 
tions, unless we would wish to expose a patient 
to the risks of mortification : for it is impossible for 
any one to calculate exactly ho>v much a wet 
roller will shrink in drying, and consequently how 
great a degree of pressure it may make on a part, 
after we have left them. A bandage may be of the 
proper degree of tightness, and the patient make 
no complaints, and yet in three or four hours be 
suffering such agonies as must be seen or felt to 
be properly appreciated. The question, then, may 
very properly be asked, as to how much traction 
should be made in order to apply a roller properly. 
This will, to a certain extent, depend on the pb- 



MINOR SURGERY. 



47 



ject with which it is applied, as a bandage which 
is merely intended to confine a dressing, need not 
be as tight as one that is to compress the muscles ; 
but, as a general rule, a dry bandage is not too 
tight if the patient feels easy under it two or three 
hours after its application ; but, until practice has 
taught the degree to which a roller should be 
drawn, the fact should be recollected that one 
which is too tight must do serious injury, while 
all that can result from one that is too loose, will 
be the non-fulfilment of tho indications for its ap- 
plication. The young surgeon had, therefore, bet- 
ter err in the latter case, as daily evidence shows 
that the tendency of all young dressers is to 
use too much traction on a bandage, and not too 
little. 

In the consideration of the special application 
of the roller we shall take up, 1st, its applica- 
tion according to the course which it may take ; 
and 2d, that resulting from the object to be at- 
tained in its application, commencing with the 
head and proceeding regularly to the toes. 

The Circular bandage is one, as has been said, 
in which each turn overlaps that which has pre- 
ceded it, so that the whole looks like a single turn, 
and runs directly 
round the part. All 
the circular ban- 
dages are very sim- 
ple, and consist of 
one for the forehead, 
in which the turns 
encompass the vault 
of the cranium ; one 




48 



MINOR SURGERY. 



Fig. 35. 



for the eyes, used to retain dressings after the 
operation for cataract ; one for the neck, as in the 
dressing of blisters, setons, &c. ; one for the arm, as 
in the compression of the veins previous to bleed- 
ing; and a few of a like nature for other parts 
of the body, as may be readily understood. 

In the confinement of the terminal end of the 
circular, or any other bandage, two means are em- 
ployed, — either the use of pins, or of little bands 
tied in bow-knots. 

If pins are used, they should be placed either 
in the direction of the length or 
breadth of the band. If in its 
length, the head should always be 
turned from the free end of the 
roller, as otherwise the tendency of 
the roller to become loose will, by 
constantly drawing against the 
head, at last withdraw the pin en- 
tirely. On the other hand, if it is 
applied transversely, the head 
should always present to the upper 
extremity of the limb, in order to prevent its 

sticking in the fingers 

Fig. 37. of the surgeon when 

his hand is passed 

down the part either 

to smooth the turns 

of the roller, or in its 

removal to seek for 

the end. (Fig. 37.) 

A reference to Fig. 36 

will show how the pin may be drawn out by the 

unwinding of the roller itself. Some persons prefer 





MINOR SURGERY. 



49 



to fasten the end of a roller by means of a 
piece of tape, or by slitting the end for a short 
distance into two strips and tying the pieces 
in a bow-knot ; but 

this is never as neat Fl £- 38# 

and firm as the pin, 
except in the ban- 
daging of fingers, 
toes, &c. 

The Oblique Ban- 
dage differs from 
the circular in the 
direction of its turns, 
by which it is en- 
abled to cover in a greater extent of surface, each 
turn being a little beyond the one previously made 
and following a course oblique to the axis of the 
limb. It is chiefly employed to retain dressings, 




Fig. 39. 




though occasionally useful when conjoined with 
other bandages in certain cases, which will be 
spoken of further on. 

The Spiral is the bandage most frequently em- 
ployed in the treatment of diseases of the extre- 
mities as well as in those of the trunk. Its turns are 
5. 



50 



MINOR SURGERY. 



not so oblique as the one last spoken of, as each 
turn covers in at least one-third of the one below 
it. As most of the parts to which it is applied are 
conical, it follows that, in the ascent from the lower 
to the upper part of them, especially in the ex- 
tremities, we must pass from the apex of the cone 
to its base, and that consequently one edge of the 
body of the roller will press on the part, while the 
other will project beyond it, and form what are 
known under the name of Gaps, as a, b, c. To obviate 

Fig. 40. 




this and cause the bandage to apply itself perpen- 
dicularly to the whole surface of the part, the rol- 
ler must be half folded on itself, or a doubling made, 
which is called a Reverse. As the bandage by 
this action acquires an increased thickness, a greater 
degree of pressure will be made on these points 
than at any other, and it is therefore desirable, in 
order to obviate the bad effects which might result 
from it, that the reverse should be as short and as 
smooth as possible. To do this, hold the roller 
in the position in which it is generally applied, 



MINOR SURGERY. 



51 



that is, either by its body or its two extremities, 
the hand being in a state of supination ; the 
fingers of the other hand are then applied to that 
part of the body of the bandage which is already 
in contact with the limb, not to assist in forming 
the reverse, or to fold it down, but simply to pre- 
vent its slipping while the reverse is being made. 
Thus fixed, we should see that no more of the 
band is unrolled than will enable us to separate 
the hand a short distance from the limb, say three 
or four inches ; and then keeping all slack between 
the fingers which fix the body of the roller and the 
part which is in the cylinder, turn the hand holding 



41. 




the cylinder from supination into decided pronation 
(Fig. 41) — taking care to make no traction, nor to 
sink the cylinder below the level of the limb till 
the fold or reverse is made, when we may again 
proceed up the limb. These reverses are indis- 



52 MINOR SURGERY. 

pensable wherever there is an increase in the 
size of the part, from the extra development of 
certain muscles ; and it is therefore of the greatest 
importance that the proper way of making them 
should be acquired, as no spiral bandage can pro- 
ceed four inches on an extremity without requiring 
a reverse. Although generally regarded as the 
most difficult point in the application of the roller, 
it is not so in reality, and a little attention to the 
rules, recollecting always that no traction is to 
he made, nor the cylinder sunk below the limb, or 
widely separated from it, while the reverse is 
forming, will enable any one after a little practice 
to make them with great ease and neatness. To 
add to the latter, they should, as far as possi- 
ble, be kept in a perpendicular line, as seen in the 
cut of the spiral of the lower extremity. 

The special applications of the Spiral Bandage 
are as follows : — 



SPIRAL OF THE CHEST. 

This is composed of a single-headed roller, ten 
or twelve yards long, and three or four inches 
wide. 

Position of the Patient. — Always sitting up, 
so that the hand of the surgeon may pass readily 
behind the back. 

Application. — The initial end is applied to the 
anterior part of one axilla, say the left ; and 
the roller is then conducted upwards across the 
front of the chest, passes over the right clavicle, 
and over the back to the point of departure; 



MINOR SURGERY. 



53 



another and si- Fig. 42. 

milar turn being 
effected, it is then 
carried across the 
front of the chest 
to the right axilla, 
to form an oblique 
from this to the 
left clavicle, after 
which it is car- 
ried firmly around 
the chest in spiral 
turns from above 
downwards. 

Use. — In fractures of the ribs, care being taken 
to apply compresses to their anterior and poste- 
rior extremities, if the fragments project inwards ; 
but if outwards, upon the parts themselves. It is 
sometimes useful to add to this the T bandage for 
the body, as seen hereafter, in order to prevent the 
roller from slipping, if the patient, from mania a 
potu or other causes, should be very restless, 




SPIRAL OF THE ABDOMEN. 

Composed of the same parts as the above. 

•Application. — Commencing at the lower part 
of the chest, carry the roller spirally round the 
abdomen from above downwards. 

Use. — To compress the abdomen, in certain 
cases, as after the operation for tapping in ascites. 
Its place may be well supplied by the double T of 
the abdomen. 
5* 



54 



MINOR SURGERY. 




SPIRAL OF THE PENIS. 

Composed of a band of 
Fig. 43. eighteen or twenty-four 

inches in length, half an 
inch wide, and slit into 
two pieces at its termi- 
nal extremity. 

Application. — ■ Com- 
mence at the base of the 
gians penis, and form 
an ordinary spiral which 
shall terminate at the 
root of the penis, and be 
confined by tying the 
two ends. 

Uses. — This is chiefly employed to retain dress- 
ings to the penis, in cases of chancres and other 
sores external to the prepuce. It has also been 
used in the treatment of gonorrhoea, in order to 
compress the urethra, a catheter being left in it; but 
it is very apt to produce erections, which do harm, 
and quickly derange the bandage. The sheath of 
the penis spoken of hereafter, answers better. 

The application of the Spiral Bandages to the 
Arm or the Forearm, is usually merely to retain a 
dressing, and may be very well included in the 
application of the spiral to the whole limb, as the 
turns in either case are the same. 



SPIRAL OF THE FINGERS. 

Composed of a roller one yard long, one inch 
wide, and split, or not, as may be, into two rib- 
bons, at its terminal extremity. 

Application. — Fix the initial extremity round 



MINOR SURGERY. 



55 



the wrist by a circular turn and cross the back of the 
hand to descend either finger to its extremity by very 
oblique turns. Commencing at its extremity, make 
an ordinary spiral with reverses,and terminate the 
bandage either by a knot or by a pin, with a few 
circular turns round the wrist, as seen in Fig. 38. 
Use. — The spiral turns of this little bandage are 
employed by every one to retain dressings to the 
finger in cases of wounds, but without the turns 
round the wrist it is very apt to become deranged. 

SPIRAL OF ALL THE FINGERS, OR GAUNTLET. 

Composed of a band, eight yards long and 



Fig. 44. 



one inch wide, rolled 
in a cylinder. 

Application. — Com- 
mence the bandage by 
one or two circulars 
around the wrist ; pass 
obliquely over the back 
of the hand, and by 
oblique turns descend to 
the nail of the forefinger; 
then by spiral reversed 
turns, ascend to its base \ 
pass to the middle fin- 
ger ; descend by oblique 
turns to its nail ; ascend 
by spirals to its base, 
and so on, till all the 
fingers are covered in, 
terminating at the base 
of the little finger, then 
pass in front or on the back of the hand to finish 
by circulars around the wrist. 




56 



MINOR SURGERY. 



Use. — We may resort to this bandage when more 
than one finger is injured, and there is reason to fear 
their uniting if they are permitted to come in con- 
tact, as in cases of burns. To this should be added 
the demi-gauntlet, double T of the hands, or per- 
forated T, if there is a necessity for retaining dress- 
ings at the metacarpal extremities of the fingers. 



DEMI-GAUNTLET. 



Fig. 45. 




Composed of the 
same as the preceding. 

•Application. — Make 
a few circular turns 
around the wrist and 
pass across the back or 
palm of the hand, as 
the case may be, by ob- 
lique turns which will 
pass from the root of 
each finger to make a 
circular turn round the 
wrist. 

Uses. — To retain 
dressings to the front 
or back of the hand. 
Its place may be well 
supplied by the perfo- 
rated T, or the double T 
of the hands. 



SPIRAL OF THE UPPER EXTREMITY. 

Composed of a roller, eight yards long, two or 
two and a half inches wide, and compresses, if it 
is required as a Compressing Bandage. 

Application. — Having covered in the fingers 



MINOR SURGERY. 



51 



if necessary by the gauntlet, commence with one 
or two circular turns around the wrist, in order to 
fix the end of the bandage, then pass obliquely 
over the back of the hand and palm, to reach the 
extremities of the fingers, ascend by three spiral 
turns without reversing, which brings us to the 
phalangeo-metacarpal joint of the thumb ; cover 
this and the wrist-joint by a figure of 8, as will 
be described hereafter, and ascend the limb by 
spiral and reversed turns, till we reach the elbow ; 
cover this also by a figure of S, if the arm is to be 
flexed, if not, by simple spiral turns without re- 
verses, and continue the spiral and reverses to the 
shoulder, placing compresses, &c, where they may 
be required. 

Fig. 46. 




Use. — To cover in, support, and compress the 
whole limb, as in varicose veins, aneurismai tu- 
mours, treatment of fractures, &c. 

Position of the Patient. — Sitting, or lying 
down, with the arm and forearm extended, and 
the palm of the hand looking forwards, the thumb 
being widely separated from the hand. 



58 MINOR SURGERY, 

The effects of this bandage, when well applied, 
are excellent ; but it may become very fatiguing 
and painful if drawn tight, and if too tight, may 
produce gangrenous ulcers of the skin. In 1&37 
it was found necessary in the Pennsylvania Hospi- 
tal to amputate the forearm of a man who had had 
only a simple fracture of the lower extremity of the 
radius, but whose arm was gangrenous from the mal- 
application of this bandage by a country surgeon. 

The spiral of the thigh,of the leg,of the foot, and-of 
the toes, are similar to the above, and may therefore, 
be included in the 

SPIRAL OF THE LOWER EXTREMITY. 

Composed of two simple rollers,each eight yards 
long and two and a half inches wide. 

Position of the Patient. — If possible, seated 
with the extremity of his heel on the very point 
of the surgeon's knee, or else laying down, and the 
leg supported by assistants. The surgeon may be 
either at the foot, or on the outside of the limb, 
and either sitting or standing. 

•Application. — Commence by making one or 
two circular turns^ immediately above the malleoli, 
to fix the end of the roller, then descend, if in the 
right foot, from the external malleolus obliquely 
across the instep and under the sole to the extre- 
mity of the little toe ; from this make two or three 
oblique turns which will cover in the foot as far 
as the instep, and then cover in the heel by turns 
of the figure of S, one extremity of the eight em- 
bracing the heel and ankle, the other the instep ; 
after which, ascend the limb by spiral reversed 
turns, which may be made with either hand, until 



MINOR SURGERY. 59 

you reach the knee. Cover in this joint by a 
figure of 8, and proceed with the second roller to 
make spiral reversed turns on the thigh, till the 
whole is covered in. 

Uses. — This bandage, if well applied, fulfils 
every indication either in the treatment of frac- 
tures, ulcers, varicose veins, or oedema, and will 
usually keep its place, if the patient remains in 
bed, for two or three days. The main difficulty 
in its application consists in the covering in of the 
heel. This is not absolutely necessary, as the 
close adhesion of the integuments to the parts 
below, prevents any great amount of swelling; 
but where a considerable degree of compression 
is made on the leg, it is a better plan to cover in 
the heel entirely. To do this, proceed from the 
inside of the instep of the right foot under the 
heel to its outside, then around its point to the in- 
side, forming a cap for the heel, round under the sole 
of the heel up across the instep, to go round the point 
to the opposite side and come up over the out- 
side of the ankle, then over the instep, under the 
sole, up over the ankle in front, over the internal 
malleolus, round to the external, and then up the 
limb. The turns on the heel and foot are seen in 
the figure. The ad- 
vantages of the circular *%. 47. 
turns round the ankle 
in commencing this 
bandage, are, that it 
gives greater firmness 
by preventing the in- 
itial end from becom- 
ing loose. The French 
surgeons, ho we ver,usu- i 




60 



MINOR SURGERY. 



ally begin it at the toes, and do not cover in the 
heel, and their course may be pursued by those 
who may deem it best, by observing the rules for 
the application of the 



FRENCH SPIRAL. 



Fig. 48. 



Composed of a roller, two and a half inches wide 

and seven yards long. 

Application. — Place the in- 
itial extremity on the outside of 
the instep, say of the right foot, 
and pass obliquely across to the 
ball of the big toe undfe'r the sole 
to the extremity of the little toe, 
and then make as many spiral 
reversed turns as will carry us to 
the front of the ankle, or the front 
of the astragalus. Pass from this 
around the malleoli, and ascend 
the limb by spiral reverses, as in 
the former bandage. The re- 
verses of this and the former ban- 
dage being the same, are shown 
in this figure, the only difference 
being in the turns to cover in the 
heel. 

Uses. — Same as the ordinary 
spiral. This bandage is the one 
best adapted for the application 
of the Dextrine or Starch Ban- 
dage, as it leaves the toes and 
heel open to inspection, as will 
be seen in the treatment of frac- 
tures. Where it is necessary to 

make pressure on the instep, heel, and ankle, the 




MINOR SURGERY. 



61 



spica of the foot may be added to this with ad- 
vantage. 

THE CROSSED, OR FIGURE OF 8 BANDAGES, 

Compose some of the best and neatest applications 
of the roller, and are so named from their shape. 
They are exceedingly useful in covering in joints and 
other points which require a firm and solid compres- 
sion, and are made both with the single and dou- 
ble-headed roller, though, as the compression result- 
ing from the turns of the latter is sometimes very 
painful and requires watching, it is seldom used in 
this country. 

CROSSED OF ONE EYE. 

Composedoi a single-headed roller, two inches 
wide and five yards long. 

Application. — If the hair is long, cover in the 
head first with a nightcap to prevent the first turns 
of the roller from slipping, and then make two or 
three circulars round the forehead and occiput; pass- 
ing from right to left if for the left 



eye, and the reverse if for the 
right. Then on reaching the 
nape of the neck in the third 
turn, carry the roller under the 
ear of the affected side, and 
then obliquely up over the jaw 
and the injured eye, inclining it 
well to the internal canthus, 
so as to cover the root of the 
nose, but not affect the sound 
eye ; pass hence across to the 
temple of the sound eye ; de- 
scend to the nape of the neck, 
6 



Fig. 49 




62 MINOR SURGERY. 

and make thus two or three oblique turns {a a a), 
and terminate by circular ones around the fore- 
head (b b b). 

Use. — This answers tolerably well to retain 
dressings to the eye, but is very readily displaced 
by the movements of the patient. When, there- 
fore, it is important to make pressure on the ball 
of the eye, as in the treatment of gonorrheal oph- 
thalmia, cancer, &c, &c, it is better to cover in 
both eyes by the use of the following, or else 
employ the simple circular bandage of the eyes. 

CROSSED OF BOTH EYES. 

Coinposed of a single or double-headed roller, 
seven yards long and two inches wide, with com- 
presses, if required. 

•Application. — Make two or three circular 
turns of the head, turning indifferently from right 
to left, or the reverse ; then reaching the back of 
the neck, pass under the ear of one side, up over 
the eye, root of nose, and parietal protuberance 
of the opposite side, to return to the neck. Make 
two or three turns like this, and at the third pass 
from the parietal protuberance round the forehead 
instead of round the occiput, to cross the root of the 
nose, the eye, and cheek of the opposite side, mak- 
ing an X with the first turns ; proceed in oblique 
turns as before, and terminate by circular ones. 

Uses. — This is much more solid than the for- 
mer, and may be employed in similar cases. It 
adds much to its solidity to cover in the head, after 
its application, with a handkerchief or nightcap. 

CROSSED OF THE ANGLE OF THE JAW. 

Composed of a single-headed roller, two inches 



MINOR SURGERY. 



63 



wide and five yards long, and of a thick com- 
press. 

Application. — Carry the initial portion of the 
bandage around the forehead, and fix it by 
two circulars of the vault of the cranium, turning 
from the right to the left and backwards, if the 
disease is on the left side : from the nape of the 
neck, direct the roller close under and behind the 
ear of the sound side, under the jaw to the angle 
of the jaw on the in- 
jured side, placing F ' l S- 50. 
the compress behind 
and on this angle. 
Then carry the roller 
over the compress, 
up over the side of 
the face, between the 
eye and left ear, ob- 
liquely over the ven- 
tex, and down be- 
hind the ear oppo- 
site the injured side. 
Make thus three or 
four oblique turns, as 
seen on the right side 

of the figure, and terminate by circular turns 
around the forehead. 

Use. — This is an excellent bandage for the 
treatment of fracture of the neck and angle of the 
jaw, as it forces the angle forwards to the anterior 
portion. It is also useful in tumours of the paro- 
tid gland, and generally in retaining dressings to 
this region. No circular turns should be made 




64 



MINOR SURGERY. 



around the chin and neck, as sometimes recom- 
mended in cases of fracture of this part of the jaw, 
as these tend to displace the fragments, and push 
the chin too much backwards. 



CROSSED, OR FIGURE OF 8 OF THE JAW. 

Bartorts Bandage. 

Composed of a single-headed roller, five yards 
long and two inches wide. 

Application, — Place 
Fig. 51. the initial extremity of 

the roller just below the 
prominence in the os 
occipitis, continue it ob- 
liquely over the centre 
of the parietal bone, 
across the junction of 
the coronal and sagittal 
sutures, over the zygo- 
matic arch under the 
chin, and, pursuing the 
same direction on the 
opposite side until you 
arrive at the back of the 
head ; then pass it obliquely around and parallel 
to the base of the lower jaw, over the chin, and 
continue the same course on the other side till it 
ends where you commenced, whence we run ex- 
actly the same course, fixing the bandage by a 
pin at the vertex. 

Use. — For this beautiful specimen of a ban- 
dage we are indebted to the skill and ingenuity 




MINOR SURGERY. 65 

of Dr. J. Rhea Barton, of Philadelphia, a surgeon 
to whom the profession owe many very important 
and novel operations, and whose skill in the use 
of bandages is unsurpassed by any one. It is an 
admirable dressing for fractures of the lower jaw, 
anterior to its angle, and requires but one or, at 
most, two pins, which is a great advantage. In 
order to apply it neatly, the roller should not be 
over two inches wide, and the turns should follow 
as nearly as possible those which have preceded 
them, thus giving the appearance of but a single 
turn. 

CROSSED, OR POSTERIOR 8 OF THE CHEST. 

Composition. — A roller, five yards long, two 
and a half or three inches wide, and compresses, 
or cotton, to place on the anterior edge of the axillae 
to prevent the bandage from chafing them. 

Position of the Patient. — Sitting with the 
shoulders well drawn back by one assistant, whilst 
another retains the compresses on the axillae till 
after the first turns of the roller. 

•Application. — Carry the initial extremity of 
the roller around the superior part of one arm, as 
the left, and make three or four spiral reversed 
turns from before backwards, and from within 
outwards. From this shoulder pass obliquely 
over the back to the right axilla, the shoulders 
being well forced backwards. Ascend in front 
of, and over the shoulder, to pass over the back to 
the left axilla, over the compresses in front of this 
and round to the back, over it to the right axilla, 
over it in front, and over the back to the left 
6* 



66 



MINOR SURGERY. 



axilla, to pass again the same course till the roller 
is nearly exhausted, when it maybe terminated 
by circulars of the body, or of the right arm. 




Use. — This bandage may be either a uniting 
one for the back, or a divisive one for the front of 
the chest. It was formerly employed in the treat- 
ment of fractured clavicle, but its place has been 
supplied by others, though it may occasionally be 
a useful addition to the ordinary dressings, where 
it is requisite to carry the shoulder well back- 
wards. It is also useful in longitudinal wounds 
of the back, or in preventing contractions from 
burns on the front of the chest. 



MINOR SURGERY. 



67 



ANTERIOR 8, OR CROSSED OF THE FRONT OF THE CHEST. 

This is precisely the same as the former, but in 
regard to the opposite points of the body. Its 
composition and application can therefore be rea- 
dily understood from the figure, and what has 
been just said. It draws the shoulders forwards 
— of course, would unite longitudinal wounds 
over the pectoral muscles, and prevent contrac- 
tions in the cicatrices of burns of the back. By 
placing compresses over the upper part of the 
sternum, it may also be usefully employed in in- 
juries of this part. 

Fig. 53. 




68 



MINOR SURGERY. 



SPICA OF THE SHOULDER. 

Composed of a roller, eight yards long, two and 
a half inches wide, and of cotton, or a compress, 
for the axilla of the injured side. 

Application. — Commence the bandage by 
making one or two spiral reversed turns round 
the upper part of the arm of the injured side, pass- 
ing from without inwards, and from before back- 
wards : pass from behind the arm up over the 
lower extremity of the shoulder, obliquely down- 
-r,. KA wards over the 

front of the chest to 
the axilla of the 
sound side ; thence 



round the back ob- 
liquely upwards, 
over the shoulder, 
and down it in front 
under the axilla of 
the injured side, 
previously furnish- 
ed with a compress 
or cotton ; then be- 



hind and upon the 
shoulder to pursue 
exactly the same 
course, covering in, 
however, only one- 
third of the prece- 
ding turn, until the 
bandage is nearly 
exhausted, when it 
may be terminated by one or two circulars of the 
trunk or of the arm, or pinned, as in the cut. 
Uses. — This neat bandage, named from the 




MINOR SURGERY. 



69 



resemblance in its folds to the arrangement of the 
leaves of an ear of corn, exercises a very exact 
compression around the point of the shoulder, and 
will thus depress the humeral extremity of the 
clavicle in cases of dislocation of that bone, pro- 
vided the arm is also well supported. Care is re- 
quisite to protect the edges of the axilla, as other- 
wise they will be cut by the turns of the roller. 

When the turns of this roller mount gradually 
from the point of the shoulder towards the neck, 
it is called a Spica Ascendens, but if its turns come 
from the neck to the shoulder, it becomes a Spica 
Descendens. Of course, it is optional with the 
surgeon to make either the one or the other, as it 
will depend on the point where the first turn is 
made after leaving the arm. 

FIGURE OF 8 OF THE NECK AND AXILLA. 

Composed of a roller, five yards long and two 
inches wide. 



Application.—*- 
Place the in- 
itial extremity of 
the roller on the 
side of the neck, 
and fix it by 
one or two circu- 
lars of the neck, 
loosely applied ; 
making them, for 
example, from 
behind forwards, 
and from left to 
right. Direct the 
roller as it comes 



Fig. 55. 




70 MINOR SURGERY, 

from the left side of the neck over and behind 
the right shoulder, confining any dressings that 
may be required either here or in the axilla ; 
come up in front and over the shoulder, and then 
round the neck to the left side to follow the same 
course, covering only one-third of the preceding 
turns, and making a figure of 8, one turn of which 
shall embrace the neck, and the other the axilla. 

Uses. — This bandage is very useful in retaining 
dressings before, behind, or above the shoulder, and 
also to the axilla or base of the neck, as it is easily 
made ; and if not drawn too tight does not restrain 
the motions of the arm. It may also be made 
with a double-headed roller, the body of the ban- 
dage being applied under the axilla, and the heads 
crossed upon the shoulder of the opposite side, 
and then brought round the neck to cross on the 
injured shoulder and axilla of the same side. It 
is firmer, as thus applied, than the single-headed 
roller, but may press too much on the armpit, if 
care is not used in its application. 

CROSSED OF ONE BREAST. 

Composed of a roller, of eight yards by two and 
a half inches. 

Position of the Surgeon in front and on the 
outside of the limbs of the patient, not in front of 
the knees, as this becomes awkward in the last 
turns of the bandage. 

Application. — Fix the initial extremity behind 
the shoulder of the affected side, the right, for 
example. Carry the roller obliquely across the 
back over the opposite shoulder, and descend on 
the front of the chest to pass from before back- 



MINOR SURGERY. 



71 



wards and under the breast and axilla of the in- 
jured side. Fix by this turn the initial extremity 
of the roller, and go over the same course to form 
two or three obliques of the neck and axilla. On 
coming to the ax- 
illa of the diseased Fi S- 5G - 
breast the third 
time, direct the 
roller transversely 
across the back to 
the axilla of the op- 
posite or left side, 
and return by a 
horizontal turn in 
front of the chest to 
the point of depar- 
ture to commence 
another oblique of 
the neck and axilla. 
Continue thus mak- 
ing obliques of the 
neck and horizon- 
tal turns of the body, each turn ascending and 
covering in one-third of the preceding one till the 
roller is exhausted. 

Use. — This bandage is not only useful in re- 
taining dressings to the breast, but also in sup- 
porting the breastitself, when requisite, as in cancer, 
lactation, &c, as it will very readily keep its place, 
unless picked at, for thirty-six hours. It may, how- 
ever, be supplanted by the sling of the breast, as 
described hereafter, if it should be requisite to 
change the dressing twice or thrice a day, as this 
saves the fatigue of a reapplication. 




72 



MINOR SURGERY. 



CROSSED OF BOTH BREASTS. 

Composed of a roller, ten or twelve yards long 
and two and a half inches wide, rolled either into 
one or two heads. If the patient is very fat, it 
may require a roller of fifteen yards. 

Application. — Carry the initial extremity of 
the roller behind the right axilla, thence by cross- 
ing the back, direct the cylinder over the left 

Fig. 57. 




shoulder, pass obliquely across the front of the 
chest under the right breast, and under the right 



MINOR SURGERY. 73 

axilla to the point of departure. Make thus two 
or three obliques of the neck and axilla, covering 
in the breast by the gradual ascent of each turn, 
and on reaching the back of the right axilla in the 
third turn, pass transversely across the back to the 
left axilla, under this and across the chest in front 
of the left breast to the right side of the neck, 
thence across the back to the same axilla, the left. 
Make thus two obliques of the neck and this 
axilla, and on coming to the front of this axilla 
pass transversely under both breasts to the right 
axilla, and under this to the point of departure. 
Care should be taken that each convolution cover 
successively the breasts from below upwards, 
without being drawn too tight. If the course here 
laid down be rigorously followed, we shall have 
an oblique of the neck and each axilla with ho- 
rizontal turns before and behind, and the turns of 
the roller will mould themselves with great accu- 
racy to the roundness of the breasts. 

Use. — This is employed like the preceding one, 
to support or compress both breasts, and is exceed- 
ingly useful in patients who are annoyed by pen- 
dulous mammae during lactation, &c. 

The same bandage may be well made by means 
of a double-headed roller. In this case, place the 
body of the bandage in front of the sternum, and 
carry each cylinder under its respective axilla, to 
form an oblique of the neck and axilla, crossing 
on the back. After one or two obliques, carry one 
cylinder horizontally in front of, the other behind 
the chest, to make a half transverse turn, and 
then make other oblique and semi-transverse turns 
till the whole is covered. 
7 



74 MINOR SURGERY. 



APPARATUS OF M. RECAMIER, FOR THE TREATMENT 
OF CANCEROUS TUMOURS OF THE BREAST, AS MADE 
BY THESE CROSSED BANDAGES. 

Composed of two single-headed rollers, two or 
two and a half inches wide and eight yards long; — 
disks of agaric,* varying from the size of a six- 
pence to that of a dollar. 

Application. — Should the person be young, 
or one whose breasts are but slightly developed, a 
few horizontal turns of one of the above-men- 
tioned rollers usually suffices, a disk or two of 
agaric, dependent on the number and the volume 
of the engorgements, being previously applied to 
the tumour, in order that the bandage may exer- 
cise a more perfect compression on the part. 
When, however, the mammae are voluminous and 
soft, it is necessary to give them such a degree of 
solidity, that the engorged point may be prevented 
from escaping from beneath the compressing body ; 
this is effected by the rollers being made to form 
the figure of 8, or crossed bandage of both breasts ; 
each of the branches will then tend to elevate the 
inferior part of one breast and depress the superior 
part of the other ; a disk of agaric is now to be 
placed upon each of these organs, and confined by 
the turns of the roller ; other disks are placed over 
this, diminishing in size, and interposed between 
each circumvolution of the bandage, until the 
cone has acquired a sufficient projection. 

When the compression is only required to be 
effected upon one breast, the crossed of one breast 
is used. 

* Boletus Igniarius. 



MINOR SURGERY. 



75 



Obse?*vations. — The manner of applying this 
bandage must of course vary according to circum- 
stances, but in every case the compression which 
is required to be exerted should be equal upon 
every point of the tumour, and moderately strong. 
The apparatus should be removed and reapplied 
once at least every twenty-four hours, in order 
that its action be constantly the same, — a thing of 
great importance as regards the result of the 
treatment. 



SPICA OF THE GROIN, OR FIGURE OF 8 OF THE PELVIS 
AND THIGH. 

Composed of a single-headed roller, eight yards 
long by three inches wide, and of compresses, if 
required. 




Application. — Place the initial extremity above 
one of the iliac crests, and make two horizontal 
circular turns above the pelvis to fix it, turning 



76 MINOR SURGERY. 

from right to left and from before backwards, if 
for the right groin, and the reverse if for the left. 
Arriving in front of one of the groins, say the 
right, place the compresses or other dressings in 
their position, and descend across them to the inside 
of the thigh between it and the genital organs, and 
winding round the back part of the thigh, ascend 
on its outside, to cross the first turn, thence to the 
iliac bone of the opposite side, across the back 
and round the pelvis, to follow the same course 
until the cylinder is nearly exhausted, when it 
should be fixed by a circular of the pelvis. 

Use. — To retain dressings, or make compression 
on buboes, venereal ulcers, abscesses, &c, situated 
at the groin. If it is intended to make a Spica 
Ascendens, the first turn over the groin should go 
as far down the thigh as we wish to cover by the 
bandage, and each turn, covering in only one-third 
of that which preceded it, should gradually mount 
upwards. If, on the contrary, we wish to force 
matter from above downwards, the first turn 
should cross the groin high up near the abdomen, 
and by descending form a Spica Descendens. 

This bandage of the groin is exceedingly useful 
after operations for hernia, or in other cases of 
hernia where compression is required and a truss 
cannot be borne or obtained. 

SPICA FOR BOTH GROINS. 

Composed of a single-headed roller, ten yards 
long and two and a half inches wide. 

•Application. — Two horizontal turns are first 
made about the pelvis, going, for example, from 
right to left and from before backwards ; upon 
arriving, at the second turn, near the left groin, 



MINOR SURGERY. 



77 



the head of the roller is made to pass obliquely 
downwards along the outer side of this thigh, and 

Fig. 59. 




ascend along its inner side to cross the first de- 
scending turn ; it is next conducted round the back 
of the pelvis as far as the right groin, and passing 
hence along the inner side of this thigh, remounts 
on its outer side, and is carried again round the 
pelvis in front ; the head of the roller is then made 
to pursue the track just described, until only a 
sufficient quantity remains to terminate the ban- 
dage by two more horizontal circulars of the pelvis. 

Use. — Same as the former, but for both groins. 

The spica of both groins may be very advan- 
tageously made with a double-headed roller. The 
body is applied to the front of the abdomen in a 



78 



MINOR SURGERY. 



line with the crests of the ilia, and each head car- 
ried around them, to cross behind the back and 
come round on each groin. Then let each one 
descend in the line of the groin between the geni- 
tals in the inside of each thigh, and pass under, 
behind and on the outside of them, to run, one to 
the right, the other to the left iliac crest, and thence 
round the back to follow the same course. 

No bandage can be firmer or simpler than this, 
where it is requisite to make firm compression on 
each groin. 

FIGURE OF 8 OF THE ELBOW. 

Composed of a roller, two yards long and two 

or two and a half inches wide. 

•Application. — Place the initial extremity on 

the external and upper part of the forearm, and 

pass obliquely over the 
Fig. 60. bend of the arm to the 

internal tuberosity of the 
humerus, round and 
above the olecranon to 
the external tuberosity, 
thence obliquely across 
the front, crossing the 
first turn in X to the 
inner and upper part of 
the forearm, and then 
across the back to the 
point of departure, to 
run the same course. If 
the arm is much flexed, 

make one circular over the point of the elbow 

after the formation of the second figure of 8. 




MINOR SURGERY. 79 

Use. — This little bandage is very useful in 
covering in the elbow-joint, when the arm is 
either flexed or extended, and is therefore added 
to the Spiral of the Upper Extremity for this pur- 
pose. It is also much employed to retain the 
compress used after bleeding, as will be seen 
hereafter. 

FIGURE OF 8 OF THE WRIST. 

Composed of the same as the preceding. 

Application. — Make one or two circulars 
around the wrist, either on its back or palmar face, 
to fix the end of the bandage, and on reaching the 
cubital side, run obliquely across to the space 
between the thumb and forefinger, say of the right 
hand, then obliquely over the palm to a corre- 
sponding point on the metacarpal bone of the little 
finger, hence obliquely across the back of the 
hand to the wrist-joint, whence make a semi-ho- 
rizontal turn around the wrist to the ulnar side, to 
run the same course over again, as seen in the 
Spiral of the Upper Extremity. 

Use. — To cover in and compress the wrist- 
joint. This is also added to the Spica of the Upper 
Extremity in order to cover in this joint. 

SPICA OF THE THUMB. 

Composed of a roller, three yards long and a 
finger's breadth wide. 

•Application. — Fix the initial end upon the 
wrist by two or three circulars ; after the last turn, 
which should be terminated upon its radial side, 



80 



MINOR SURGERY. 



Fig. 61. 



direct the head 
of the roller from 
the external to 
the internal side 
of the thumb, 
pass between this 
and the index fin- 
ger, to return and 
cross the base of 
the thumb and 
carry it onward 

again about the wrist : these double obliques are 

to be repeated, so as to form a spica, till the whole 

of the bandage is exhausted. 

Use. — Principally in dislocation of the first 

metacarpal bone. It may be used also for the 

roots of either of the fingers. 




FIGURE OF 8 OF BOTH THIGHS. 

Composed of a few turns of -a roller, two and a 
half inches wide. 

•Application. — Fix the end by one or two cir- 
culars of the middle of the right thigh, pass from 
the front of this to the back of and under the left, 
round its outside to the front, then over to the 
under part of the right, round it to the front, 
thence under the left thigh, and so on till three or 
four turns are made. 

Use. — To keep the thighs together after the 
operation of lithotomy, or after the reduction of 
a dislocation of the femur. 



MINOR SURGERY. SI 



FIGURE OF 8 OF THE KNEE. 

Composed of a roller, two and a half inches 
wide. 

•Application. — Fix the initial extremity by one 
or two circulars below the knee, then pass ob- 
liquely over the patella, say from the outside to 
its inside ; make a semi-horizontal turn on the 
back of the thigh above the joint to reach the ex- 
ternal condyle, go thence obliquely over the patella 
to the inner side of the tibia, pass round behind it 
to the head of the fibula, and run the same course 
again till all is covered, as seen in the Spiral of the 
Lower Limbs. 

Use. — To cover in the knee or compress the 
joint in various cases. This is added to the Spiral 
of the Lower Extremity, in order to cover in this 
joint. It is also used in fracture of the patella. If 
it is wished to retain a dressing to the popliteal 
space, we have only to reverse the turns of this 
bandage, that is, start it by circular turns from 
within outwards, and cross from below the knee 
behind to above it in front. 

FIGURE OF 8 OF THE ANKLE AND INSTEP. 

Composed of a roller, two and a half inches wide 
and the ordinary length. 

application. — If in the right foot, place the 
initial extremity above the external malleolus, and 
make two circular turns to fix it ; then on coming 
to the external malleolus on the second turn, pass 
obliquely over the front of the instep to the tarso- 
metacarpal articulation of the big toe, thence under 



82 



MINOR SURGERY. 




the sole of the foot to the out- 
Fig. 62. si(j e , horizontally over the in- 
step to the same point, and 
then pass obliquely over to 
the external side of the os 
calcis, over this side of the 
bone, and round its point, up 
on its inside to cross the ante- 
rior extremity of the astragalus, 
over the upper part of the in- 
step, clown the outside at the 
point of the cuboid bone, under 
the sole to the inside of the calcis, around its point 
to the outside, and up over the instep to the point 
where the cuneiform internum is placed, and thence 
follow a similar course till the heel is covered in, 
which is generally done in two turns and a half 
of figures of 8. To cover in the extreme point of 
the sole of the heel, be careful that each turn that 
goes over the sole is kept as much backwards 
towards the point of the heel as possible, as the 
bandage will not slip off if drawn moderately 
tight. If it is not necessary to cover in the heel, 
the turns may be as in the figure. 

Use. — This bandage may be resorted to where 
we wish to retain dressings to the heel or instep, 
or front of the ankle-joint, as in the excoriations 
from the extending band of the apparatus for 
fracture of the thigh. It is also added to the Spiral 
of the Lower Extremity, where we wish to cover 
in the heel as well as the whole limb, as in the 
Compressing Bandage. 



MINOR SURGERY. 



S3 



SPICA OF THE INSTEP. 

Composed of a single-headed roller, seven yards 
long and two inches wide. 

Application* — Lay the initial extremity of the 
roller on the tarsal end of the metacarpal bone of 
the little toe^ if in the right foot, on that of the big 
toe, if in the left. Hence pass obliquely over the 
front of the foot to the first joint of the big toe in 
the right foot, or to that of the little toe if in the 

Fig. 03. 




other. Then go under the sole of the foot horizon- 
tally in a line with the metacarpo-phalangial 
articulation, to the outer or inner side of the foot, 
according as it is the right or left. From this point 
make two obliques over the front of the foot, 
which will bring us to the instep on its inner or 
outer side, and then pass directly to the point of 
the heel in a line parallel with the sole of the foot, 
the edge of the roller projecting a little beneath the 
sole, thence around the heel to come to the instep 
again, keeping still parallel with the sole of the foot, 



84 MINOR SURGERY, 

cross the instep and make another turn similar to 
the first, which shall embrace the heel and instep, 
cover in one-third of the preceding turn, and form 
a spica on the instep. Continue these turns, gra- 
dually ascending, till the foot will hold no more, 
when we may terminate the bandage by circulars 
above the ankle, or else form a spiral up the limb. 

Use. — This forms a most excellent bandage 
for cases requiring firm compression of the instep 
or ankle, as in wounds of the anterior or posterior 
tibial arteries at these points, and is at the same 
time exceedingly neat in its appearance : the figure 
also shows the proper position of the limb of the 
patient and of the surgeon. For it, as well as for 
many other practical details, I am indebted to M. 
Ribbail, of Paris, from whose excellent course on 
Minor Surgery, much that is of daily service has 
been gained. 

The Figure of 8 of the Toes, or the Spica of the 
Big Toe, is so precisely similar to these bandages in 
the fingers and thumb as not to require arepetition. 
In applying any of them, make a few circulars of 
the instep instead of the wrist, and then proceed 
exactly as in the hand. 

THE KNOTTED BANDAGES, 

Named from their making a knot like that 
known as the Packer's Knot, are made of double- 
headed rollers, and are intended to make firm com- 
pression on particular points, as on bleeding ves- 
sels, &c. The only one of them of any importance, 
is that of the head, for arresting hemorrhage from 
the temporal artery, though under the same class 
might be included all those which are terminated 
by bows, as in the 8 of the elbow after bleed- 



MINOR SURGERY. 



S5 



ing at the 



bend of the arm that of the ankle, as 
well as the Sailor's Knot, clove-hitch, and others 
employed in the treatment of Dislocations. 



KNOTTED BANDAGE OF THE HEAD. 

Composition. — A simple band, five yards long 
and two inches wide, rolled up into two heads of 
unequal size, one being a fourth larger than the 
other. 

•Application. — Place the body of the bandage 
over the graduated compress that covers the 
wounded artery, and 
conduct the two heads *X§r. 64. 

before and behind, to 
the opposite temple, 
where we reverse them 
in order to return to 
the point of departure ; 
now give them a turn 
or twist, which enables 
us to carry one over 
the summit of the head, 
and the other under- 
neath the chin, to the 
sound side, where they 

meet and reverse as in the first instance ; from thence 
they are to be conducted in the same course, to the 
point of departure on the wounded vessel, and a 
second twist being effected, conduct them for the 
third time to the opposite temple, and for the third 
time also return horizontally and knot them firm- 
ly, each knot being behind the one first formed : 
being conducted finally, the one head over the 




86 MINOR SURGERY. 

vertex, and the other underneath the chin, the 
bandage is terminated by a few circulars of the 
forehead and occiput. 

Use. — For stopping hemorrhage of the temporal 
artery, or any of its branches ; it is, however, a 
painful bandage, from the compression made on 
the lower jaw and point of injury, and requires 
attention, in order that it shall not remain on too 
long or be too tight. It is useful to close the 
opening in the vessel first, with a piece of adhe- 
sive plaster, as will be seen hereafter when treating 
of arteriotomy. 

THE RECURRENT BANDAGES, 

Are formed by convolutions or parabolic and 
recurrent turns, which make a kind of cap for the 
parts to which they are applied. Unlike most 
caps, however, they are exceedingly apt to become 
relaxed, and although very neat in their appear- 
ance, require more watching than is convenient, 
and are therefore often supplanted by other dress- 
ings. When required, they may be made either 
with the single or double-headed roller ; but from 
the difficulty of removing the latter without its 
coming off in mass, and thus perhaps bringing liga- 
tures, &c, altogether, that formed by the single- 
headed roller is the one most generally employed. 

RECURRENT OF THE HEAD. 

Composed of a single-headed roller, five yards 
long and two inches wide. 

Application. — Place the initial extremity on 
one side of the head on a line with the supra- 
orbital ridge, and carry the cylinder two or three 



3HN0R SURGERY. 



87 



times round the head by circular turns. On coming 
to the middle of the forehead in the second turn, 
reverse the bandage and confine the reverse with 

Fig. 63. 




one hand while the cylinder is carried over the 
top of the head in the line of the sagittal suture, 
to the occipital protuberance ; reverse here, and 
let an assistant fix the reverse; then come obliquely 
over the head to the forehead, make another re- 
verse to go to the occiput, each turn covering in 
one-third of the preceding one, and continue thus 
till we reach the horizontal turn on the right or 
left side of the head, then cover in the opposite 
side by similar turns, each reverse being at the 
same point, in front and behind, and terminate the 
bandage by circular turns firmly applied. 



88 



MINOR SURGERY. 



Fig. 66. 



jj se% — To retain dressings to the head, as in the 
application of blisters to the scalp — in erysipelas, 
and other diseases of the scalp, &c. Care, however, 
must be taken not to draw the horizontal turns 
too tight, lest, as in the case related by Percy, ul- 
ceration or gangrene ensue. 

RECURRENT OF THE HEAD OF TWO GLOBES. 

Composed of a double-headed roller. 
•Application. — The body of the bandage is to be 
placed upon the occiput or forehead, and after two 
or three circular turns the rollers should intersect 
each other upon the occi- 
put ; one of them is then 
reflected over the vertex to 
the forehead, and the other 
continued in a circular 
course around the head. 
They next cross each other 
upon the forehead, when 
the first head is carried ob- 
liquely backwards to the 
occiput, and reflected by 
the side of the other. The 
last, a, is continued in a 
circular direction, but the 
first, 6, is again brought 
over the head, from behind forwards, and carried 
in this way backwards and forwards in reverses 
till the head is entirely covered. 

Use. — This, like the previous bandage, serves 
to confine dressings upon the head, but is rarely 
now employed for the reasons stated ; the ancients 
exerted, by its means, compression on the heads of 
hydrocephalic patients. 




MINOR SURGERY. 



89 



RECURRENT OF AMPUTATIONS. 

There are two varieties of this, according as it 
is made with a single or double-headed roller : as, 
however, it is difficult to remove the latter, I shall 
only give the application of the former, which is 

Composed of a single-headed roller, of different 
lengths according to the volume of the stump to 
be covered, but generally two or two and a half 
inches wide. 

Position of the patient, such as is most easy to 
him, with the stump well supported and the integu- 
ments pushed well over the end of the bone, by 
assistants. Then having arranged the Maltese 
Cross and other dressings — 

Jipply the initial end on the surface of the stump, 
about three or four inches above its extremity, 

Fis. 67. 




90 MINOR SURGERY. 

make two or three circulars to fix this, and on 
coming to the central point of the under portion 
of the stump — reverse, so as to run up in front of 
the stump and over its upper surface to a point, A, 
four inches above its extremity. Fix these re- 
verses by the fingers of one hand, and continue to 
make them till the whole face of the stump is 
covered, when we terminate by spiral reversed 
turns, which, starting from the circumference of 
the stump, B, runs up a few inches above 
the first turn of the bandage, where it is to be con- 
fined by a pin. If there is a tendency to spasm 
of the stump, the ends may be carried on and fixed 
fast to the pillow or bed on which the limb lies, 
and will thus prevent its jumping. Care is re- 
quisite not to draw the recurrent turns at A too 
tight, as these, by compressing the soft parts 
against the point of the bone, cause irritation and 
spasm. 

This figure also shows the application of a Sus- 
pensory Bandage, for the testicles. 



SECTION SECOND. 

OP THE COMPOSITION AND APPLICATION OF THE COMPOUND 
BANDAGE, OR THE BANDAGE PROPER. 

It has been already stated that usage had justi- 
fied the application of the term Bandage, to what 
should be strictly known only as the Roller, and 
that we should therefore designate what is the 
Bandage proper under the head of the Compound 
Roller or Bandage. These include a considerable 
number of our most useful means of retaining 
dressings, and their application is generally very 



MINOR SURGERY. 



91 



simple, though they are a little complicated in 
their composition. To the latter, therefore, we 
shall pay the most attention, hoping to render it so 
plain that any one may be enabled to make them 
properly. 

THE T, OR CRUCIAL BANDAGE, 

Named from its shape, is composed of a hori- 
zontal portion, ota. length sufficient to go entirely 
round the part and 



leave enough to make 
a bow-knot, and of a 
vertical piece,which is 
half the length of the 
horizontal one and ge- 
nerally attached firm- 
ly to its middle, so 
as to form the per- 
pendicular portion of 
the T. Each portion 
should be rolled into 
a cylinder, and con- 
fined by a pin pre- 
vious to its applica- 
tion, in order to en- 
sure its smoothness 
when applied. The 
vertical portion varies 
considerably in its 
shape and length, but 
these are exceptions 
to the general rule ; 
sometimes it is three 
or four inches wide, 
and slit into two tails 
to within a short dis- 



Fig. G8. 



Fig. 69. 




92 



MINOR SURGERY. 



tance of the horizontal band, as in Figure 69 ; 
at others a triangular piece is added, &c., &c., as 
will be seen hereafter. 

T BANDAGE OF THE HEAD. 

Composed of a bandage, two yards long and two 
inches wide, upon which, at about one-third of its 
entire length, a bandelette half a yard long and of 
the same width, is stitched at right angles. The 
bandage is rolled up into two heads previously to 
its application. 

.Application. — Placing himself before the pa- 
tient, the surgeon applies the body of the bandage 
to the middle of the forehead, the uppermost edge 

being that which corres- 
Fi £' 70 - ponds to the vertical por- 

tion of the bandage, in 
order that the latter, after 
traversing the vertex, 
may hang loosely upon 
the nape of the neck • he 
now unrols the heads in 
passing them along the 
temples to the occipital 
region, where they cross 
the bandelette, which 
should be immediately 
reflected upwards, and 
secured upon the brow 
by a few turns of the double heads, or horizontal 
portion. A double T may be formed by simply 
stitching a second bandelette upon the transverse 
portion of this, at a convenient distance from the 
first. 

Use. — This is a retaining bandage ; and should 




MINOR SURGERY. 93 

be so placed that the vertical band may run over 
the point to be covered in. It is preferable to the 
recurrent bandage of the head, where the dressing 
is small, as it is not so heating. If likely to be 
deranged by slipping upwards, a band may be 
added, which shall pass under the jaw. 

T BANDAGE OF THE EAR. 

Composed of a horizontal band, two yards long, 
of a vertical one, a half yard in length, and of 
a piece of linen of the shape and size of the external 
ear. Sew the hori- 
zontal band to the Fig. 71. 
summit of the ear- 
shaped piece of mus- 
lin, and attach the 
vertical one to the 
opposite part, or that 
corresponding with 
the soft part of the 
ear. 

•Application. — Fix 
the circular band over 
the earof the affected 

side, and place the muslin over or close behind the 
ear; then carry the vertical band under the jaw 
and up on the opposite side, where it may be con- 
fined by the horizontal turns. 

Use. — This modification of the T is an excel- 
lent bandage for retaining dressings to or behind 
the ear, especially the latter. Every one has felt 
the difficulty of retaining blisters or dressings to 
this part, but the construction of this little ban- 
dage removes it entirely. If made of black silk 
and narrow ribbons, it would hardly be noticed in 




94 



MINOR SURGERY. 



persons wearing whiskers, or in those wearing caps 
or bonnets. 

DOUBLE T OF THE NOSE. 

Composed of a band, one inch wide and two 
yards long, of two other bands of the same width, 
but one yard long. Sew these latter on the for- 
mer, so that they may be one inch apart, and at 
right angles to the first band. 

Jlpply the transverse band upon the upper lip, 
turning the border to which the vertical bands are 
sewed, upwards, then carry the two extremities 
over each cheek, and under the ears to the nape 
of the neck, where they are to be held by an as- 
sistant. Then cross the vertical bands upon the 

root of the nose, and carry 
each one over the parietal 
protuberance of its side, 
and down to near each 
mastoid process, under 
the horizontal band. Turn 
them over this to come 
upwards, and fix them by 
bringing the remains of 
the horizontal band from 
its crossing on the nape 
of the neck round the 
forehead, where it may 
be fastened either by a 
knot or a pin. 

Uses. — This is an ex- 
cellent bandage to retain dressings to the upper 
lip and root of the nose, especially to the latter in 
cases of fracture of its bones, or in epiphora or 
fistula lachrymalis, as it is easily renewed, and 




MINOR SURGERY. 



95 



does not interfere with the use of the eyes, nose, 
or mouth. 

The single T bandage of the nose is a very use- 
ful one in retaining dressings to its surface, but as 
it is much improved by the addition of a suspen- 
sory, it will be treated of under those bandages. 



DOUBLE T OF THE CHEST. 



Composed of a napkin, or large compress of the 
same form, folded lengthwise in three ; — and of 
a band two feet long, split nearly to the end, or 
of two distinct bands of the same length. 

•Application. — The 



napkin, 



a, is 



passed 



Fig. 73. 



behind the shoulder- 
blades, and the two 
extremities brought 
forwards on the chest, 
upon which they are 
made to overlap ; they 
are then pinned, and 
the unsplit extremity 
of the band, or the 
bands themselves be- 
ing next fastened to 
the posterior part of 
the body-bandage, the tails are brought forward 
one over each shoulder, and secured in front, c c 
to form shoulder-straps. 

Use. — To confine dressings upon the chest ; to 
furnish points for the attachment of other ban- 
dages, and in cases of fracture to compress the 
ribs. 



i 




96 MINOR SURGERY. 



DOUBLE T OF THE ABDOMEN. 

Composed of a napkin, or a piece of linen of the 
same form, folded in three, to one of the borders 
which are stitched, at equal distances from its 
centre, two narrow bands half a yard long, to serve 
for thigh-straps ; they should be attached suffi- 
ciently apart to correspond with the great trochan- 
ters. 

Application. — The middle of the napkin is ap- 
plied upon the loins, the extremities are brought 
round, on to the abdomen, upon which they are 
overlapped and pinned ; the vertical bands are then 
conducted from behind forwards, crossed under 
the perineum, and fixed upon the forepart of the 
horizontal band. 

Use. — To retain poultices or other dressings 
upon the abdomen, to exert compression on this 
part after the operation of paracentesis, or after de- 
livery, and to furnish points for the attachment of 
parts of other apparatus. 

This, it will be seen, is the T of the chest re- 
versed, the vertical bands being made to pass 
under the pelvis instead of over the shoulder. 

TRIANGULAR, OR COMPOUND T OF THE GROIN. 

Composed of a triangular piece of linen, four 
inches wide at its base and ten inches long, and 
of a triangular shape in order to correspond with 
the upper and internal part of the thigh; to the 
base of this is sewed a horizontal band, of about 
a yard and a half in length, and to its summit a 
vertical one three-quarters of a yard long. 



MINOR SURGERY. 



97 



, Application. — The extremities of the horizon- 
tal band are carried round the pelvis on either side 
as far as the sacrum, 
whence they are re- 
turned and tied in a 
bow, above the pubes, 
while the vertical band, 
passing downward be- 
tween the thigh and 
scrotum, comes up over 
the outside of the thigh, 
and is attached to the 
transverse portion of 
the bandage. 

I r se. — To retain 
dressings upon the 
groin of a patient con- 
fined in bed, as in poul- 
ticing of buboes, and after operating for hernia, &c. 
This is one of the best bandages that can be em- 
ployed for retaining dressings to the groin, when 
it is requisite to renew them frequently, or where 
it is difficult to move or raise the patient, as with this 
it is only necessary to untie the vertical band and 
draw it from under the thigh, in order to lay open 
the whole groin to our view ; and this may be 
readily done without the least movement on the 
part of the patient. 




DOUBLE T BANDAGE OF THE PELVIS. 

Composedoi a roller, of sufficient length to pass 
twice or three times round the pelvis, and three 
9 



98 



MINOR SURGERY. 



Fig. 75. 




inches wide ; — two ver- 
tical bands, each half a 
yard in length, and an 
inch in breadth, are to be 
stitched to the horizontal 
roller at right angles, and 
at about one-fourth of its 
entire length. 
Application.— The trans- 
verse portion of the ban- 
dage is glided under the 
loins above the pelvis, so 
that the vertical bands may- 
correspond to the median line of the posterior face 
of the pelvis ; and its extremities being passed 
round the body, are fixed with pins; these bands 
are then brought under the perineum, crossed, and 
directed upwards and outwards to be fastened to 
the anterior part of the roller. 

Use. — To maintain a dressing or surgical ap- 
paratus to the perineum, anus, or vagina, as in 
cases of piles, prolapsus ani, &c. Instead of the 
two tails, that formed by slitting the single T may 
be used, as seen in Fig. 69. 

T BANDAGE OF THE HANDS. 

Composed of a narrow bandage or piece of tape*, 
one inch wide, half a yard long, and of a second 
piece one yard long. Sew the longest piece to 
the other to form the vertical portion of the T. 

Application. — Place the horizontal band on 
the back or front of the wrist, so that the vertical 
band may present to the fingers. Carry this over 
the back or front of the hand, over the interdigital 



MINOR SURGERY. 



99 



space of the first and second finger, come up again 
to the wrist, and surround the vertical band by a 
half turn of the horizontal one. Reverse the first 
over the latter to return to the space between the 
middle and third finger, retaining the dressing and 
coming up to the wrist again, surround it by the 
horizontal band, reverse the vertical one in order to 
pass between the ring and little finger, and on the 
outside of the latter to the wrist, where fasten it 
by the turn round the wrist. 

Use. — This is a very light bandage for retain- 
ing dressings to the interdigital spaces as well as 
the body of the hand, and oilers a substitute for 
the gauntlet or demi-gauntlet, as before seen. 

T PERFORATED OF HAND. 

Composed of a two inch roller, one yard long, 
and of a piece of mus- 
lin of the breadth and Fig, 76. 
twice the length of 
the palm of the hand. 
Fold this on itself in 
its length, and cut in 
it four circular open- 
ings, D, about three 
lines apart, to corre- 
spond with the fin- 
gers, then sew one 
of its extremities at 
right angles to the 
roller or horizontal band, as in Fig. 76. 

•Application. — Pass the fingers through the 
openings, arid stretch the muslin over the back 
and front of the hand, confining the loose end by 




100 MINOR SURGERY, 

a few circular turns of the roller around and above 
the wrist. 

Use. — Same as the above. 

The T bandages of the feet are similar in their 
formation and application to the above. 

INVAGINATED, OB SLIT AND TAIL BANDAGES. 

These bandages might also be classed under the 
Uniting Bandages, as the general object, of their 
application is to bring separated parts into contact. 
They consist of two kinds, one in which the same 
roller is formed at one end into strips or tails, and 
at another part, into slits or button-holes, and the 
second, in which two distinct bands are thus pre- 
pared, as seen further on. In either case, the tails 
of the one are passed through the openings in the 
other, and by acting on compresses, force all the 
parts under them to approximate, The first is 
employed to assist the union of longitudinal, the 
other of transverse wounds, as well as in the treat- 
ment of certain fractures. When wounds are 
deeply seated, the application of adhesive strips 
only unites the surface and leaves the parts below 
separated, so that, as the secretion of pus goes on, 
a bag or cyst is formed, from which it cannot 
escape except by burrowing underneath. When, 
also, divided parts have a tendency to contract, 
they very frequently tear out the stitches, and it 
is in both these cases that these bandages are ex- 
ceedingly useful. 

INVAGINATED FOR VERTICAL WOUNDS OF THE LIP. 

Composed of a roller, two or three yards long 



MINOR SURGERY. 



101 



and one inch wide, rolled into two heads, and of 
two small compresses about two inches square, 
which are to be placed on the cheeks near the 
angle of the mouth. 

•Application. — Place the body of the roller on 
the forehead, or on the nape of the neck near the 
occiput, and carry each head round over the lower 
part of the ear, un- 



Fig. 77. 



der the malar bones, 
and over the coin- 
presses to the lip. 
Then slit in one 
bandage a hole large 
enough to admit the 
other head ; pass it 
through and draw 
upon each roller ; 
carry them round to 
(he neck, and then 
run the same course 
till the parts are well 
supported and cover- 
ed in, as in Fig. 77, and terminate on the fore- 
head. 

Use. — In vertical wounds of the lip, to support 
the harelip suture and prevent its cutting out. 
By the pressure which it makes on the lip, it is 
also useful in arresting hemorrhage from the co- 
ronary arteries. 




M. THILLAYE S BANDAGE FOR THE SAME. 

Composition. — Four pieces of tape are required, 
each about two feet in length, and broad in pro- 
9* 



102 MINOR SURGERY. 

portion to the depth of the lip, a a a a ; to the 

extremities of 

F & 78 - two of these 

^£^>. bands, which 

1jLJq^^^^^^^^^^^^^- / minated poste- 
^^~^k^^^^^^^^^K ^ r i° r > are stitch- 
IJlp^^^^^^ ed two small 
^CJL/ linen pledgets 
or cushions, b b, 
about three-quarters of an inch square; while the 
two extremities of the others, or anterior tapes, 
are folded under, to have more solidity. Upon the 
extremity of one of these, are stitched three strips 
of extremely narrow riband, c c c, three inches and 
a half long, to connect it with one of the pledgets, 
to which also they are to be in like manner fast- 
ened, with a small space left on the free edges : 
four strips of riband, d d d d, similar to the first, 
are stitched to the extremity of the anterior tape 
of the opposite side, which, after being passed 
through the intervals of the first set, are fixed to 
the other pledget. By this disposition the bande- 
lettes attached to either of the anterior tapes will 
be found attached to the pledget of the opposite 
side ; the free extremities of the tapes are then 
rolled up and pinned. — Two small graduated 
compresses, eight lines long by six wide ; — two 
pads large enough to occupy the space compre- 
hended between the zygomatic arch on each side, 
and the inferior maxillary bone ; — a single-headed 
roller of moderate size ; — and two bandelettes, 
one a foot, and the other a foot and a half long. 

application. — The single-headed roller is first 
of all passed horizontally round the patient's head, 



MINOR SURGERY. 



103 



Fig. 79. 



to afford points for the fixing of certain parts of 
the apparatus ; after which, an assistant applies 
at the distance of half an inch from the incised 
part, the graduated compresses, e e, which he re- 
tains in place while the surgeon applies the cen- 
tral portion of the quadruple-headed roller upon 
the lip ; the latter then car- 
ries the heads of the poste- 
rior bands to which the 
pledgets are attached, in a 
horizontal direction, over 
the cushions,// placed be- 
tween the zygomatic arch 
and the lower edge of the 
inferior maxillary bone, as 
far as the nape of the neck ; 
from hence, after crossing 
each other in changing 
hands, they are made to 
ascend obliquely to the 
forehead, where the ends, 
g g, are pinned to the cir- 
cular roller. Laying now 

hold of the anterior bands, we pull them in 
opposite directions, and bring, by the aid of the 
pledgets, the edges of the wound into contact ; 
the heads of these two bands pursue the same 
course as those of the preceding, and the ends are 
fixed in like manner to the circles of the first roller. 
The bandelettes serve to render the apparatus 
more secure ; the first, A, passes along the sagittal 
suture, being attached before and behind to the 
circumvolutions of the roller ; and the second, be- 
ing applied by its middle, z, to the chin, passes 
upward to the temples, where it is fixed to the 




104 MINOR SURGERY. 

same circular turns ; a few stitches, k k, are in- 
serted to connect it with the pads, and the whole 
is retained by the sling or four-tailed bandage of 
the chin. 

INVAGINATED OF THE BODY. 

Composed of a double-headed roller, of a length 
sufficient to go several times round the body, and 
of two compresses of the length of the wound. 

•Application. — Place the body of the bandage 
on the back, and bring the heads round under 
each axilla, and over the compresses on each side 
of the wound. Make a slit in the body of one 
side, and pass the cylinder of the other side through 
it, by which means the wound will be well closed. 
Continue this as often as may be necessary. 

Use. — To unite longitudinal wounds of the 
chest or abdomen, or to support the parts after the 
removal of the breast. 

JNVAGINATED, OR UNITING BANDAGE FOR LONGITUDI- 
NAL WOUNDS OF THE EXTREMITY. 

Composition. — One end of a piece of linen, of 
sufficient length to make three or four cir- 
Fig. 80. cumvolutions of the member, and of a 
breadth correspondent to the length of the 
wound, is divided so as to form three tails, 
about an inch broad, and long enough to 
embrace three-fourths of the circumference 
of the limb : at a convenient distance fur- 
ther on, are made three longitudinal perfo- 
rations, opposite to, and of the same breadth 
as the tails. The remainder of the band is 
then rolled up ; — two common graduated 
compresses also are required. 




MINOR SURGERY. 105 

•Application. — The undivided portion, situated 
between the tails and the perforations, being ap- 
plied upon that 
part of the limb 
which is ex- 
actly opposite 
the wound, the 
graduated com- 
presses, a a, are 
placed one on 
each side of the 
latter, at the 
distance of about three fingers' breadth from its 
edges; the tails, b b b, are then passed through 
the corresponding perforations, c c c, and the sur- 
geon brings the edges of the wound in contact, by 
drawing the extremities of the band in contrary 
directions : the rest of the application consists in 
firmly securing the tails by some circulars made 
with the remainder of the bandage. 

Observations. — This bandage may be used in 
longitudinal wounds of the upper as well as of the 
lower extremities. It may often be replaced, how- 
ever, with advantage, by strips of adhesive plaster 
over the compresses, 'and over this a common 
dressing may be applied, and confined by a single- 
headed roller : the strips should be about a quarter 
of an inch apart where great closeness is required, 
otherwise they should be more distant ; this is an 
extremely necessary precaution, as the confine- 
ment of blood, and still more of any extraneous 
matter, would be liable to occasion the formation 
of an abscess, that would speedily disunite the 
parts if prevented from escaping. 



106 



MINOR SURGERY. 




INVAGINATED OF TWO DISTINCT BANDS, OR UNITING 
BANDAGE FOR TRANSVERSE WOUNDS. 

Composition. — A piece of muslin, or a roller 
of the same width as the wound, 
Fig. 82. and as long as the member, is to Fig. 83. 
be divided to nearly half its length 
into three tails or bandelettes ; 
another and similar piece of cloth 
should be perforated in the mid- 
dle with three corresponding lon- 
gitudinal openings. The remain- 
der of the objects consist of two 
common graduated compresses, 
and two single-headed rollers, one |§|^J 
six and the other nine yards long, 
both three fingers' breadth wide. 
Application. — The edges of the wound being 
brought together, the surgeon applies a spiral ban- 
dage to cover in the limb from its extremity up 

to the wound ; 
Fig. 84. that done, he 

extends the per- 
forated band 
along the limb, 
so as to allow 
the upper ex- 
tremity to pass 
a few inches 
beyond the 
wound, and the 
slits to lie upon the edge of the wound ; he then 
fixes this by means of spiral turns carried round 
the limb, from below up to the edge of the wound, 
and reflecting what remains of it downward, se- 




MINOR SURGERY. 



107 



cures it by a few more turns. Confiding now the 
head of the roller to an assistant, he takes the 
tailed roller, and fixes its extremity above the 
wound by a few spiral turns, and carries it spi- 
rally up and down to the lower part of the thigh. 
Lastly, having applied the compresses, c c, one 
above, and the other below the wound, he en- 
gages the tails in the corresponding perforations, 
and draws the free extremities of the bands in 
contrary directions, in order to approximate the 
edges of the wound ; when he considers them to be 
sufficiently in contact, he extends the bands along 
the limb, and while the assistants maintain them 
firmly fixed, confines them with what remains of 
the two rollers. 

The cut shows this bandage applied to a trans- 
verse wound above the knee. 

Observations. — This bandage may be replaced 
by the annexed, which, in point 
of fact, is a dry suture. Let two 
long strips of adhesive plaster 
(spread on strong linen) be pro- 
cured, together with several bits 
of narrow tape. The parts be- 
ing put into a complete state 
of relaxation, pass the straps 
about the limb, above and be- 
low the wound, at a convenient 
distance from its borders, as 
represented in the wood-cut ; 
then passing through these two 
bands the bits of tape, tie their 
extremities together. But 
which ever of the two means 
just described be employed, it 




10S 



MINOR SURGERY. 



will in general be necessary to give the divided parts 
greater support than either of them can effect alone : 
recourse must therefore be had, under such cir- 
cumstances, in order to afford this additional sup- 
port, to bandages calculated to ensure the approxi- 
mation of the edges of the wound. Thus, in divisions 
of the flexor muscles, the limb must be kept bent ; 
-while, on the contrary, in cases where the exten- 
sors are concerned, the limb should be maintained 
upon the full stretch by the application of a splint 
made to pass along it, upon the side opposite the 
injury. 



UNITING OF ONE SIDE, OR A BANDAGE FOR WRY-NECK. 

Fig. 




Composition. — A single-headed roller, three 



MINOR SURGERY. 109 

yards long and an inch 'and a half wide ; — some soft 
compresses or a cushion to protect the axilla against 
the pressure of the roller ; — and a napkin to sur- 
round the trunk. 

•Application. — The initial extremity, a, of the 
roller being directed toward the affected side, is 
placed upon the middle of the forehead and 
fixed by a few horizontal circulars ; these should 
be secured with pins. The remainder, i, of 
the roller is then carried behind the shoulder op- 
posed to the side affected, and under the axilla, 
where the cushion or padding ought to be pre- 
viously placed, and thence to the forepart of the 
napkin, to which it should be firmly stitched; 
care being taken, however, to pull the head over 
with sufficient force to restore it to its natural 
position. 

Use. — In cases of spasm or paralysis of the 
sterno-cleido-mastoidean and platysma-myoides 
muscles. It raises the head, brings round the face 
forward, and, when the affected parts have been 
operated on, opposes itself to the contractile efforts 
of the antagonist muscles. 

PROFESSOR JORG'S APPARATUS FOR THE SAME. 

This apparatus consists of a pair of leather stays 
and of a band or fillet for the head ; on the centre 
of the forepart of the stays is a sort of pulley or 
groove, which can be turned round with a key in 
one direction, but becomes fixed in the other, 
through the means of a spring ; a band passes ob- 
liquely upwards from the pulley to the fillet, to 
which it is attached behind the ear ; when the 
band is drawn downwards by the pulley, it lowers 
10 



HO MINOR SURGERY. 

the mastoid process and approaches it to the ster- 

Fig. 87. 




num ; it counteracts in this way the antagonisting 
muscles, and restores the head to its natural posi- 
tion. 

UNITING BANDAGE FOR TRANSVERSE WOUNDS OF THE 
NECK. 

Composition. — A single-headed roller, four 



MINOR SURGERY. 



Ill 



yards long ; — a band a foot long and three fin- 
gers' breadth wide ; — a body bandage with thigh- 
straps ; — and a compress a yard and a half long 
by eight inches wide, folded lengthwise in four. 




Application. — A night-cap, a, is fixed upon 
the patient's head by a few horizontal turns, b b, 
of the roller, which are made to fix at the same 
time the extremities of the band, c, placed by its 
centre upon the inferior part of the chin. The 
body bandage, rf, is applied round the chest and 
pinned. The centre, e, of the compress being 



112 



MINOR SURGERY. 



lastly applied upon the upper and back part of the 
head, and secured by a few more horizontal turns 
of the roller, its pendent extremities are firmly 
fastened to the forepart of the body bandage,//. 

SLINGS. 

These are light bandages of great simplicity, 
and very useful in retaining simple dressings, as 
they do not heat the part. They are formed of a 
piece of muslin of various lengths and width, 
split at each extremity into two or three tails up 
to within a few fingers' breadth of their centre, as 
seen in the figure. They are also occasionally 

formed of a 
Fig. 89. piece of muslin 

of a size suffi- 
cient to cover 
the part, to each 
end of which 
are attached 
two bands to 
serve as tails, thus making it resemble the slings 
employed in war by the ancients for hurling stones, 
whence their name. In using the sling, the body 
or central part is first applied over the part, and 
the tails are carried round it and confined by knots 
or pins. 





SLING OF SIX TAILS, OR THE BANDAGE OF GALEN. 

Composed of a piece of linen, a yard long and a 
quarter of a yard wide, split at each end, to within 
three fingers' breadth of the centre, into three por- 



MINOR SURGERY. 



113 



tions, the central being somewhat broader than the 
others. 

•Application, — The surgeon placing the ban- 
dage upon the summit of the head, takes first the 
central tails, a a a, between the thumb and fin- 
gers of each hand, and pass- 
ing them along the ears, Fig. 90. 
secures them underneath the 
chin, 6, observing, however, 
to fold the edges of each 
tail inwards so as to give it 
a triangular form, the base 
corresponding to the unsplit 
portion ; the frontal tails are 
then to be directed from the 
anterior to the posterior 
part of the head, where they 
should overlap each other, 
while the occipital tails are 
brought forward and se- 
cured on the forehead by- 
pins. 




Use. 



To retain large dressings to the head. 



SLING, OR FOUR-TAILED BANDAGE OF THE HEAD. 

Composed of a strip of muslin, a yard long and 
six inches broad, split at each end to within three 
fingers' breadth of the centre. 

Jlpplication. — When the wound is on the fore- 
head, the body of the sling is applied there, and 
the two upper tails, carried posteriorly, are fixed 
at the back of the head ; the lower tails are then 
fastened either upon the vertex or beneath the 
10* 



114 



MINOR SURGERY. 




chin, as the surgeon may consider it more conve- 
nient. To confine a 
dressing upon the sum- 
mit of the head, the pos- 
terior tails, a, are brought 
down and secured be- 
neath the chin ; the an- 
terior tails, b b, after be- 
ing carried to the nape of 
the neck and crossed, 
are fixed before the 
throat, or brought again 
on the forehead (Fig. 91). 
In applying it to the nape 
of the neck, the upper 
tails are conducted over 
the forehead, from 
made to cross each other, 
they are returned, 
and fastened at the 
occiput ; the lower 
tails pass round the 
neck. 

This latter forms 
the sling of the neck, 
as in Fig. 92. 

Uses. — This ban- 
dage is a very simple 
and convenient one, 
and is of great utility 
in wounds of the head 
or neck, as it can be 
applied over every 
point of this part, by 
merely changing its direction, On the neck it 



whence, after being 
Fig. 92. 




MINOR SURGERY. 



115 



Fig. 93. 



forms an excellent bandage for retaining blisters, 
setons, &c. 

SLING OF THE CHIN*. 

Composed of a piece of muslin, six inches by- 
four, slit at each extremity for two inches. To 
each tail attach a piece of tape or band one yard 
long. 

•Application. — Place the body of the sling 
under the jaw, so that the chin may be exactly in 
its centre, then carry the two posterior tails up 
over the cheeks to the 
mastoid process of each 
side, where an assist- 
ant holds them, turn 
the anterior part of 
the sling and the an- 
terior tails upwards in 
front of the chin, and 
carry the tails under 
each ear to the nape 
of the neck, cross them 
to come forwards to 
the forehead where 
they may be knotted, 
after the tails from the 
mastoids have been 
carried under them. 

Uses. — In fracture of the jaw without displace- 
ment, and to retain dressings to the front of the 
chin or under the jaw. 

SLIXG OF THE FACE, OR MASK. 

Composed of a body piece to fit the face, and of 
four tails to hold it in its position. 




116 



MINOR SURGERY. 



Preparation. — Fold a piece of muslin, of nine 
or ten inches square, on itself, so as to form an ob- 
long square. Place this on the face so that the 
double side may correspond with the central line 
of the face, and mark on it a line, A B, and a cir- 
cular opening, C, for the eyes — make also a semi- 
circular, F, for the 
Fig. 94. mouth,and a small 

transverse cut, E, 
to correspond with 
the end of the 
nose. Cut off also 
the angles, A H, 
and I F, so as to 
give it an oval 
form, and cut out 
at G two trian- 
gular pieces, the 
edges of which are 
to be sewed together to adapt it to the projection 
of the cheek bones. Attach two vertical tails at 
G , and two horizontal ones at A ; then open it out 
and make a vertical cut, D, from the transverse 
one at the point of the nose up to the point between 
the two eyes, as in Fig. 94. 

Apply this to the face and carry the upper tails 
to the occiput, cross them to come round on the 
forehead, and carry the horizontal tails to the neck 
to return also on the forehead or chin, as in the 
same figure. 

Use. — To retain dressings to the whole face, as 
in cases of burns from blasting rocks, gunshot 
wounds, small-pox, &c. 






,s~ 


,/" 


c 

— o- 




T>! 


> G 


:< 




---— ~- 



MINOR SURGERY. 



117 



SLING OF THE BREAST. 

Composed of a square piece of muslin, suffi- 
ciently large to cover in the breast, slit for one 
inch and a half on each of its four sides, and of 
four bands large enough to go round the chest — 
these are to be sewed to its four angles. 

Application — Whilst an assistant supports the 
breast or retains the dressing, place the body of 
the sling on it, and carry the lower tails under 

Frr 95. 




each axilla to come round in front of the chest, 
and carry the upper tails on each side of the neck 
over the shoulder to be fastened to the horizontal 
band. 

Use. — To retain a poultice or other dressing to 



118 



MINOR SURGERY. 



the breast, or to support it ; but if compression is re- 
quired, the Classed of the Breast answers better. 
The Four-tailed Sling may also be usefully em- 
ployed in retaining dressings to the point of the 
shoulders, the elbow, back and front of wrist, to 
the heel and instep. In either of these cases place 
the point to be covered in the centre of the body 
of the sling and carry the tails round the part so 
as to fix it firmly. 

PURSES OK SUSPENSORIES, 

Are bags of certain sizes, which are intended to 
support depending parts, or retain dressings to them. 

THE SUSPENSORY OF THE NOSE, 

Is a neat mode of retaining dressings to the 

whole of this part, and is 

Composed of a triangular piece, cut as in the 

dotted lines B C, and C D, of the figure, and to 

which are attached 
Fig* 96. the vertical and 

horizontal bands of 
a single T. 

Application. — 
Place the nose 
within the suspen- 
sory, and carry the 
vertical band over 
the head to the 
neck, and confine 
it by the horizontal 
bands, which are 
to be crossed there 

and brought up on the forehead, and fastened as 

seen in the cut. 




MINOR SURGERY. 



119 



Fig. 97. 



THE SUSPENSORY OR BAG-TRUSS OF THE SCROTUM, 

As found in the shops, consists of a network bag 
and of bands to fasten it (Fig. 67); but as this cannot 
always be had, its place may be readily supplied 
by one formed as follows, the application of both 
being the same. Fold a piece of muslin, of a size 
to suit the part, say six inches by four, on itself, 
and cut out an opening, A, for the penis, and a 
curvilinear portion according to the dotted line B C. 
Sew the dividededges toge- 
ther, and attach a hori- 
zontal band, D, to the upper 
part, and two vertical ones, 
E F, to the lower posterior 
angle, making an opening 
or button-hole in the end 
of each band. Sew on two 
buttons on the horizontal 
band to serve for. the attach- 
ment of the vertical or pe- 
rineal bands. 

•Application. — The penis 
being engaged in the open- 
ing F, and the scrotum 
perfectly enveloped, the belt is carried round the 
pelvis, and being returned in front, is tied above 
the pubes ; the two vertical bands are then 
made to ascend from the perineum along the in- 
ferior borders of the glutei muscles, to be buttoned 
to the belt in front. 

Use. — To support and confine dressings upon 
the scrotum ; to serve also for points of attachment 
to other apparatus, and for the treatment of swelled 
testicle, hydrocele, and irreducible scrotal hernia. 




120 MINOR SURGERY. 

This bandage should be always worn during the 
treatment of acute gonorrhoea, as it diminishes the 
liability to epididymitis. 

SHEATHS, 

Are coverings intended to retain dressings to 
the penis, fingers, and toes. They are the finger- 
stalls of domestic use, and are employed daily 
by every one who has a cut finger ; a very use- 
ful application of them can be made in cases of 
gonorrhoea; where, when made large, they will rea- 
dily retain a portion of charpie to the head of the 
penis, and by absorbing the discharge prevent its 
staining the linen. They are also very useful in 
retaining poultices to the head of the penis, or dress- 
ings to chancres, &c, as they cannot be deranged 
by the erections. The band in these cases passes 
round the hips, as it does round the wrist when 
applied to the fingers. 

LACED OR BUCKLED BANDAGES, 

Are so named from the manner in which they 
are confined to the part : as they are usually ob- 
tained from the glovers and others, I shall only 
refer to them in passing. 

LACED BANDAGE FOR THE KNEE. 

This is made of an elastic tis- 
sue, as buckskin or kid, which is 
lined with India-rubber, and 
laces at the side, as seen in the 
drawing. It is sometimes em- 
ployed where constant compres- 
sion is required, as after disloca- 
tions of the patella. 




MINOR SURGERY. 



121 



THE ELASTIC LACED STOCKING FOR VARICES, 

Is employed for the com- 
pression of varicose veins, and 
also for the support of tender 
and extensive cicatrices of the 
leg, being occasionally pre- 
ferable to the ordinary-rolled 
bandage, as it accommodates 
itself perfectly to the form of 
the limb, exerts an equal com- 
pression throughout its whole 
extent, is not liable to become 
deranged, and may be readily 
worn under a boot. Where it 
cannot be obtained ready made, 
slit a common strong cotton 
stocking down the side, and 
hem in on each edge a very 
thin slip of whalebone, and have 
a few eyelet-holes worked along the edges behind 
the bones, as in the corsets of the female. Like 
these, it is to be fastened by lacing it up with a 
braid. 

LACED GAITER FOR THE FOOT. 




This is constructed like 
the knee-cap, of buckskin 
or kid, and laces along the 
outside of the foot and 
ankle. It serves admirably 
for supporting the parts after 
sprains or weakness of the 
ligaments of the lower part 
of the leg and foot. 
11 



Fig. 100. 




122 MINOR SURGERY. 



SECTION THIRD. 

OF THE HANDKERCHIEF SYSTEM OF M. MAYOR, OR THE 
SYSTEM OF PROVISIONAL DRESSINGS. 

Before taking up the consideration of particular 
fractures and dislocations, it will perhaps not be 
uninteresting to examine the new system of ban- 
daging of Mr. Mayor, or the system which pro- 
poses and practices the employment of such sim- 
ple means as are always at hand, or which may 
often supplant, with advantage, the means already 
mentioned, and supply their place whenever they 
cannot be obtained. The more readily we can 
procure these means, the greater also their sim- 
plicity and uniformity, the less embarrassing will 
it be for the surgeon to fulfil his duties, the less 
perilous will be the progress of the treatment, and 
the less doubtful the chances of its termination. 
These observations apply with particular force to 
the circumstances in which surgeons are often 
placed when practising among the poorer classes, 
in the country, in thinly-peopled districts, or in the 
army or navy, where the hospital stores may have 
failed or be rapidly diminishing. In doing this, 
Mr. Mayor has most successfully laboured, and 
made such a simplification of surgical apparatus, 
that under any — even the most disadvantageous 
circumstances, relief may be afforded, and a plan 
of cure employed as safe and as commodious as 
that used in the best appointed hospitals. 

The principle he has laid down is, to use his 
own words, " Reduire, autant que possible, tous 
les appareils a leur plus simple expression, en les 



MINOR SURGERY. 123 

rattachant a un principe unique et uniforme ; et 
faire en sorte que les pieces de ces appareils, ou 
les objets materiels d'un pansement quelconque, 
soient si communs et de telle nature, qu'ils se troll- 
vent dans toutes, ou presque toutes less circon- 
stances, toujours a la disposition du chirurgien, et 
de tout le monde ; et qu'en r absence de l'homme 
de Fart, ils puissent Stre appliques faeilement par 
le premier-venu, apres une tres-ieg&re instruction. 
En d' autres termes; trouver un moyen simple, 
facile a appliquer, sans cesse sous la main, ou 
qu'on puisse toujours se procurer, et qui soit pro- 
pre de tenir lieu de charpie, de compresses, de 
remplissages, de bandes, bandages et liens, tels 
que la chirurgie les reclame pour toute espece de 
pansement/' — Nouvcau Systhne de Deligation 
Chirurgicale, Paris, 1S3S.* Troisieme edition, 
avec un Atlas. 

This principle cannot be too highly appreciated, 
nor too generally adopted, and M. Mayor has 
eminently succeeded in carrying it out ; although 



* To reduce as much as possible all kinds of apparatus 
to their most simple principles, by making them dependent 
upon one particular and uniform idea ; in order that the parts 
of such apparatus, or the material objects of any dressing, 
may be so common, and of such a nature as to be met with 
under every or nearly every circumstance, no less at the dis- 
position, always of the surgeon, than of other persons ; and 
that, in the absence of a scientific man, they may be applied 
with facility by the first comer, after very little instruction. 

In other words, to find out a means, simple, easy of appli- 
cation, ever at hand, or at least always to be obtained, which 
may replace lint, compresses, bags, bands, bandages, and 
ligatures, such as surgery ordinarily requires for the various 
species of dressing. 



124 MINOR SURGERY. 

for many years exposed to the sneers and ridicule 
of his professional brethren, and his plans of treat- 
ment are meeting everywhere with the respect 
they merit, and are daily becoming adopted, not 
only in very many parts of the Continent, but even 
in this country. 

It would be impossible in a work of this de- 
scription to consign all this celebrated surgeon's 
objections to the common modes of dressing and 
bandaging, or give the fullest details of his me- 
thod of treatment : we will, however, condense 
the most interesting of his matter, believing that 
many valuable hints may be derived from it, even 
by those who would not feel inclined to abandon, 
altogether, the older and still more usual methods 
employed in the treatment of surgical accidents. 
In the meanwhile, it is recommended to those who 
are masters of the French language, to procure the 
original work. 

It has not been M. Mayor's object, as he 
expressly says, " to banish wholly from the domain 
of surgery, charpie, lint, bands, &c, notwithstand- 
ing that such would be rigorously possible ; but 
he has been so often struck with their abuse and 
their almost exclusive employment, that he could 
not forbear exposing their numerous inconve- 
niences in practice, and endeavouring to establish 
his own motives for what he admits to be their 
quasi-exclusion" 

The principal objection made by that gentle- 
tleman, to the common bandages, is in relation to 
their frequent absence in the time of need, and 
the occasional impossibility of procuring them ; 
then the serious inconveniences with which their 



MINOR SURGERY. 125 

application may be attended when performed by- 
unskilful hands ; for it is an undisputed fact, that 
even under the best instructions the habit of ap- 
plying them is slow in being acquired, and sus- 
ceptible of being speedily lost. Bandages, too, 
are liable to become relaxed, easily deranged, and 
corded, thus inflicting injury in a variety of ways, 
and rendering their frequent re-application a matter 
of essential necessity : their diversity of length and 
breadth is also more or less perplexing to some; 
to roll them well, not a little troublesome ; and 
when to these well-founded objections to their ex- 
clusive employment, is added the difficulty of 
having them always clean and neat, as well, also, 
as the little care that patients take of them when 
they are not absolutely wanted, it must be evident 
that some other means are requisite, to rid the 
surgeon of so many causes of vexation and em- 
barrassment ; and that, when such are found, they 
must be hailed by the profession with something 
like satisfaction. 

As a bandage is acknowledged to be injurious 
which effects an unequal pressure, and becomes 
corded or otherwise deranged, it must appear quite 
evident that, were a certain degree of thickness 
afforded it, together with the greatest possible 
breadth, these effects would be readily obviated. 
Now, all the inconveniences here spoken of may 
be avoided, and all the good desired, obtained, 
from a bandage either of the original form of a 
cravat or pocket-handkerchief, or of the principal 
deligatory modifications of this, adapted to the 
nature of the case. M. Mayor makes four modi- 
fications of a handkerchief or cravat-shaped piece 
11* 



126 MINOR SURGERY. 

of linen, subservient to all the objects of a ban- 
dage. These are, the oblong, the cravat- shaped > 
the triangular, and cordiform ; the latter is only 
employed as a substitute for a cord, or strong tie, 
in certain apparatus, and is obtained by twisting 
a cravat. 

None of the objections made to the ordinary 
bandage can be applied to this. It is found every- 
where, and under every circumstance ; is easily 
adapted to its purpose ; is not liable to become 
relaxed or otherwise deranged, and cannot be- 
come corded ; is easy to fasten ; may be changed 
and reapplied with the utmost promptitude, as a 
single circumvolution of it is often equal to a mul- 
titude of turns of the common band ; is also more 
economical, as it may always be washed, and 
made ready to apply to other than surgical pur- 
poses ; the thickness and breadth can be varied at 
will : in short, it is so much the more perfect as it 
forms one whole, while each turn of a common 
band, being considered as a piece apart, the de- 
rangement of one necessarily entails the derange- 
ment of all the rest. 

It is not pretended by M. Mayor, let it be again 
observed, that this new description of bandages 
can supply, completely, the place of common sur- 
gical bands ; for, as he justly observes, there are 
cases which require a methodic compression of a 
certain energy, more particularly some affections 
of the breasts and of the extremities ; but these are 
comparatively rare ; and exception being made of 
such, the new description, as being the most valua- 
ble, should be employed in common, while bands 
should form but the exception to this general rule. 



MINOR SURGERY. 127 

With regard to the advantages derivable from 
the substitution of soft rag for charpie, in the view 
of economy, little need be said, as the latter article 
is in this country so rarely used ; still, the com- 
mon objections to the employment of charpie will 
in many instances be found equally applicable as 
regards lint, and more particularly in this, that 
lint, like charpie, cannot be washed ; like it, too, 
it often becomes musty when kept for some time ; 
and, consequently, its application to wounds would 
thus be rendered highly injurious. 

What is the end proposed in the application of 
lint or charpie to the surfaces of wounds ? Is 
there in either one or the other any intrinsic me- 
dical virtue ? or are they simply placed there, to 
serve for protection, while nature and constitu- 
tional remedies are actively engaged in operating 
the cure ? Why may they not be replaced by old 
linen, which is not only as soft and as free from sti- 
mulation, but, if judiciously selected, quite as pe- 
netrable ? Pieces of old linen are applied as easily 
as lint, more easily than charpie, and may be 
lifted off with greater facility than either, causing 
the patient by no means as much pain. 

In short, linen rag possesses striking advantages, 
not only in the cases wherein water and mucilages 
are used as a remedial agent, or rather as an aux- 
iliary of nature, but even in those in which cerates 
and ointments are employed. 

In some particular surgical diseases, the affected 
surfaces require a sort of bedding of a very soft 
and supple character, and to fulfil this indication 
something is exacted of the nature of lint or 
charpie : this species of material is necessary also 
for the construction of tentes, &c, in sinuses and 



128 MINOR SURGERY. 

fistulous openings. Now, instead of lint or charpie 
in such cases, M. Mayor strongly recommends the 
use of Carded Cotton. This substance is much 
more abundant, much more easily obtained, 
lighter, somewhat easier of application, and ad- 
heres so much better, that it rarely requires the 
superaddition of a retaining bandage. With re- 
spect, however, to the latter quality, this might in 
certain circumstances be considered an objection- 
able one ; but in point of fact, where, in the re- 
moval of the cotton, the nascent cicatrix might be 
endangered from the attempt at tearing it sud- 
denly away, every possibility of accident may be 
obviated by moistening it well with warm water, 
when it will be found to detach itself with the 
utmost facility and in mass. 

It may, perhaps, be sometimes advisable to 
apply round the edges of the wound a protective 
bandelette, or strip of spread cerate, or, where the 
wound is not very extensive, to cover the whole 
application with a piece of adhesive plaster : so 
that when the cerate is taken off, the whole mass 
may follow without any dragging. 

In its use, however, to suppurating sores, we 
should always recollect the caution given in re- 
gard to it under the head of dressings, viz., to see 
that it is free from the eggs of the fly, as they, by 
being hatched, will invariably generate maggots. 

In the application of the handkerchief, or trian- 
gular piece of linen, to cases to which it may be 
adapted, M. Mayor commences at the head, and 
then, as in our own arrangement, proceeds regu- 
larly to the trunk and extremities, and in pursuing 
this course, he designates his handkerchief ban- 
dages by certain names, which may at first sight 



MINOR .ST'RGERY. 



129 



appear to be unnecessary and pedantic ; but when 
it is recollected that the arrangement of the name 
shows the course to be pursued in the application 
of the handkerchief, it will be seen that it is of 
considerable importance, and that it aids us mate- 
rially in their application ; thus, in the Jronto-occi- 
pital triangle, we have the shape of the handker- 
chief, and the statement of the fact that.it is to he 
first applied to the forehead and then to pass to the 
occiput; so in the Jronto-cervico-labialis, or the <>c- 
cipitostcrnaly we know that it should cover, first the 
forehead, then the Deck, then the lip: whilst the other 
starts from the occiput and ends at the sternum. 

THE HANDKERCHIEF, OH SQ1 ARE LINEN. 

The IIaxdkerciiief,or Square Linen, may, by 
itself, replace all 
the bandages that 10L 

we have before 
treated of, and in 
its dimensions, as 
well as in the tis- 
sue composing it, 
must be regulated 
by the size of the 
part to which it 
is to be applied, 
or the circum- 
stances of the mo- 
ment. It is, therefore, a matter of indifference, 
whether it be of silk, cotton, or linen ; and if too 
short to go round a part at the time of its application, 
may be easily lengthened by attaching to its ex- 
tremities two pieces of tape or ribbon. 

From this original piece we may form all the 




130 



MINOR SURGERY. 



others by folding it according to the dotted lines 
of the Fig. 101 ; thus, if the four angles are folded 
into the centre, g, we shall have a smaller square, 
which may be again reduced by repeating the 
process. In this shape it answers very well for 
the application of warm, fomenting poultices, 
which may be thus easily retained between the 
two layers of the handkerchief. If the square 
handkerchief is folded from angle to angle, we 
shall have the 

TRIANGLE. 

This triangle varies in size according to the part 
to be covered in by it ; though the largest of those 
employed at Lausane was about a yard in length, 
and a half yard from its summit to the centre of 
its base. When we wish to have a smaller trian- 
gle, divide this according to the line, c d, or cut 
off portions on each side. Thus formed, the parts 
of the triangle, are the base, a 6, the angles or ex- 
tremities, or points of these same letters, and the 
summit, c. In order to apply it, hold it smoothly 



Fig. 102 




by the base, placing the thumbs above or on its 
upper surface, and the fingers, widely extended 
on its under surface ; then apply the base first, and 
carry the extremities around the part so as to 
cover in the summit, making folds or plaits of any 
portion of it that may project. 



MINOR SURGERY. 



131 



The Long Square, as in Fig. 101, does not re- 
quire much explanation, as it is readily seen to be 
formed of the common square doubled once on 
itself. 

The Cravat, as in Fig. 102, is so well known, 
as also to require no explanation, the shape being 
that which we daily employ in arranging the 
covering to our necks. Like the triangle, the 
body, or base a, is the part first applied, and this 
is retained in its position by attaching its ends, 6 c, 
to other parts of the body. 

The Cord is made by twisting the cravat on 
itself, and is of great utility in compressing ves- 
sels, as a substitute for the tourniquet. 

The first application of the handkerchief is to 
cover in the whole head, and is called 



THE SQUARE CAP OF THE HEAD. 



Form the hand- 
kerchief into an ob- 
long square, and let 
the edge of the side 
to go next the head 
be two inches shorter 
than the other. Draw 
the ends of the long 
side down the side 
of the face, and tie 
them under the chin, 
then draw the inner 
ends, or those of the 
short side forwards, 



Fig, 103. 




132 



MINOR SURGERY. 



to free them from the former, and folding this part 
backwards, tie the ends on the occiput. 

Use. — To cover in the head, ears, and jaw. 



FRONTO-OCCIPITAL TRIANGLE. 

Application. — The base is placed before the 
forehead, higher or lower, according to circum- 



Fig. 104. 




stances ; and the lateral angles or tails are crossed 
at the occiput, from whence they are to be brought 
forward as far as the temporal regions, or on to 
the forehead, where they are to be fixed by 
means of pins. Fig. 104. 

The summit is then conducted and fixed at the 
occipital region, by being made to pass under the 
posterior portion, from whence it is reflected up- 
wards and pinned. Fig. 105. 



MINOS MIK.ERY. 133 

1 05. 




Use. — To retain dressings to the head. 



o» < IPITO-FRONTAL TRIANGLE. 

Application. — Base at the occiput; tails crossed 
upon the forehead. Summit passed underneath 
the frontal portion and reflected upwards. 

Use. — Same as the former, hut more useful 
when a little pressure may he required on the 
forehead. This is made by the crossing of the 
angles, or the knotting of them. 

BI-TEMPORAL TRIANGLE. 

Application. — Base upon one of the temples; 
summit turned over towards the opposite ear and 
confined by the angles carried around the head. 

Use. — To retain dressings to the temples. 

SIMPLE OCULO-OCCIPITAL TRIANGLE. 

Application. — Base stretched obliquely from 
12 



134 



MINOR SURGERY. 



the superior part of the temporal region of the 
sound side over one eye to the submastoid region 
of diseased side ; summit carried diagonally back- 
wards to the posterior portion, where it crosses at 
the side of the neck corresponding to the sound 



eye. 
Use. 



To cover in one eye. 



FRONTO-OCCIPITO-LAB1AL1S CRAVAT. 



Fig. 106. 



Application. — Body against the forehead ; tails 

first crossed at the nape 
of the neck, then brought 
forwards to either lip, 
where one is passed 
through a slit perforated 
near the extremity of 
the other; these extre- 
mities are then pulled in 
contrary directions, over 
the compresses on each 
side of the wound, and 
secured by a couple of 
small pins or a few 
stitches under the ears. 
If a triangle is used, the summit is carried to the 
occiput, passed under the first intercrossing, re- 
flected upwards and pinned. 

Use. — To sustain the union, in wounds of the 
lip, or after the hare-lip operation ; to confine 
the dressings, or to unite wounds in the absence 
of other means. 




MINOR SURGERY. 



135 



FACIAL TRIANGLE, OR MASK, 

Application. — Place 

the base under the 
chin, the summit on 
the forehead, and car- 
ry the angles over the 
ears to the vertex, 
where they may be 
crossed and brought 
on the forehead to con- 
fine the summit ; holes 
or slits are then to be 
made for the eyes, 
nose, and mouth. 

Use. — To retain dressings to the face. 




VERTICO-MENTAL CRAVAT. 



Application* — The 

body of a broad cra- 
vat is placed on the 
vertex, and the ends 
are carried under the 
chin, and fastened to 
the sides of the first 
turn, by the ears. 

Use. — To retain 
dressings under the 
chinorbaseofthejaw. 



Fie. 103. 




OCCIPITO-AURICULAR TRIANGLE. 

Application. — Base obliquely in front of the in- 
jured ear, summit carried round towards the same 



136 



MINOR SURGERY. 



Fig. 109. 



ear, one angle carried un- 
der the jaw on the side af- 
fected, to come up in front 
of the opposite ear, where 
it makes a knot which ties 
under the ear, or a turn 
around the other angle, so 
that the two may run 
round the head, the one in 
front, the other behind, to 
tie on the side. 

Use. — To retain dress- 
ings to one ear, or to the 
angle of the jaw, without 
interfering with the oppo- 
site ear. 

OCCIPITO-STERNAL HANDKERCHIEF. 

Application. — Two handkerchiefs, one in cra- 
vat, the other in triangle. Place the base of the tri- 
Fig. 110. 





MINOR SURGERY. 



137 



angle at the occiput, with the summit anteriorly ; 
the tails are then to be brought down along the 
sides of the head and face, and fastened to the 
front of a stcrno-dorsal or dorso-thoracic cravat. 

Use. — To unite wounds of the throat, and bring 
the head to the chest. 

FRONTO-DORSAL. 

Application. — Reverse of the above. Base of the 
triangle upon the forehead ; summit carried poste- 
riorly ; tails turned downwards and backwards, to 
be fastened to the back of a dorso-thoracic cravat. 

Fig. ill. 




U s6t — Reverse of the former, or for wounds of 
the back of the neck. 



PARIETO-AXILLARIS. 



Application. — Base of the triangular handker- 
chief on one side of the head, summit carried to the 
12* 



138 



MINOR SURGERY. 



opposite side, and the ends tied to an axillo-acro- 
mial cravat. 

Fig. 112. 




Use. — To bring the head to one side, as in wry- 
neck, spasm of sterno-cleido muscle, &c. 



CERVICAL CRAVAT (OF DAILY USE). 

Application. — Centre before the larynx, the 
side of the neck, or against the cervical vertebrae, 
according to circumstances ; constituting an ante- 
rior lateral, or posterior-cervical* 

Use. — As a retaining bandage for dressings 
applied to the neck. 



MINOR SURGERY. 



139 



SIMPLE BIS-AXILLARY CRAVAT. 



Application. — 
Place the centre at 
the axilla of the af- 
fected side, cross 
the tails over the 
corresponding shoul- 
der, and then carry 
them one before, the 
other behind, the 
chest, to the axilla 
of the opposite side, 
where they are to be 
secured. 

Use. — To retain 
dressings to the axilla. 



Fig. 113. 




COMPOUND BIS-AXILLARY CRAVAT. 



Fig. 114. 




•Application Place the centre of a cravat at 



140 



MINOR SURGERY. 



the axilla of the sound side, carry the tails ob- 
liquely upwards to the base of the neck at the op- 
posite side, and fasten their extremities; next, ap- 
ply the centre of a second, and smaller cravat, at 
the axilla of the affected side, and attach its tails 
to the corresponding portion of the first. 
Use. — Same, but to both axillae. 



SIMPLE BIS-AXILLO-SCAPULARY CRAVAT, OR POSTERIOR 
8 OF THE SHOULDER. 



Fig, 115. Application. — Place 

the centre between the 
scapulae, carry one of the 
tails round the corre- 
sponding shoulder and 
axilla, and fasten the 
extremity by strong 
stitches to the body of 
the cravat ; in the next 
place, conduct the other 
tail under the corre- 
sponding axilla, and 
over the shoulder, to- 
ward the extremity of 
the first, upon which it 
should be similarly se- 
cured. 

■ Same as the foregoing. 




Use. 



COMPOUND BIS-AXILLO-SCAPULARY CRAVAT. 

Application. — Knot together the two extremi- 



MINOR SURGERY. 



141 



ties of a cravat about one of the shoulders, so as 
to make of it a loose ring : next, take a second 
cravat; apply the centre of this against the ante- 
rior face of the other shoulder, and conducting the 
tails one over the shoulder and the other beneath 

Fig. 116. 




the axilla, let the first embrace the corresponding 
portion of the ring, in order that its extremity may 
be united with that of the second tail, which should 
be made previously to pass about the first, in the 
manner represented in the wood-cut. 

Use. — Same as the two preceding, but prefer- 



142 



MINOR SURGERY. 



able to either, on account of the much greater 
power it may be made to exert. 



DORSO BIS-AXILLARIS. 



Fig. 117. 



Application. — 
Place one handker- 
chief in a cravat 
round the chest under 
each axilla, and the 
other in a triangle 
on the back, with its 
base upwards. Fix 
the summit of the tri- 
angle to the circular 
era vat, and carry the 
angles over each 
shoulder and axilla 
to fasten to the cir- 
cular handkerchief 
behind, and on the 
sides. 

Use. — To retain 
dressings to these parts. If the summit is fixed to the 
circular cravat in front, and the angles brought 
over each shoulder to fasten behind, it will re- 
tain dressings to the front of the chest, and form 
a cervico-thoracic handkerchief. 




TRIANGULAR CAP OF THE BREAST. 

Application. — Base of a triangle obliquely across 
the chest under one breast — summit over corre- 
sponding shoulder, one angle over opposite shoul- 



MINOR SURGERY. 



143 



der, the other under corresponding axilla, to tie on 
the back and confine the summit 



Fig. 118. 




Use. — To retain a dressing to, or support, the 
breast. 



SUB-FEMORAL HANDKERCHIEF. 



Application. — One handkerchief in a cravat goes 
"circularly around the pelvis. The base of another, 
which is in a triangle, is applied obliquely on the 
thigh, the angles passing circularly around its 



144 



MINOR SURGERY. 



upper part, and the summit obliquely up between 
the nates, to be fixed to the circular band, as at A. 

Fig. 119. 




Use. — An excellent bandage to cover in the 
pelvic portion of the body, and the only one that 
does it with great neatness and accuracy. 



MINOR SURGERY. 



145 



INTER-FEMORAL. 

Application. — Base on the back — angles brought 
round the pelvis — summit over the perineum, to 
fasten in to the angles in front, as in the diaper of 
children. 



SINGLE SPICA, 

Apjilication. — Place the 
body of a cravat in the line 
of the groin and carry one ex- 
tremity around the pelvis, 
the other around and below 
the thigh to meet it on the 
groin. If not long enough, 
attach tapes to the extre- 
mities. 

Use. — To retain a dressing 



Fig. 120. 



to one groin. 




DOUBLE SPICA. 



Fig. 121. 



Application. — Fold two 
handkerchiefs in cravats, 
and tie an extremity of each 
together. Place the knot a 
little on one side of the spine, 
and carry the other extre- 
mity of each, round over 
each innominatum in the 
line of the groin, between 
the thighs, and round their 
outside, to come up and fasten on to the bodies of 
the cravats. 

Use. — To retain dressings to both groins. 
13 




146 



MINOR SURGERY. 



SUSPENSORY OR SCROTO-LUMBAR TRIANGLE. 

Application. — Form a lombo-abdominal cravat 
for a belt, and apply the base of a triangle to the 

under and back part of 
Fig. 122. the scrotum ; carry the 

tails up alongside of this 
to the forepart of the 
belt, about which, pass 
them from before back- 
ward, as represented in 
the wood-cut, and tie 
the extremities, so as to 
bring the knot in front, 
and prevent its chafing. 
Next carry the summit 
upwards, pass it under 
the transverse portion of the tails and under the 
belt, reflecting it over the forepart of the appa- 
ratus, so as to secure it with a pin. 
Use. — To support the testicles. 

CERVICO-BRACHIAL SLING. 




Fig. 123. 




Application. — 
Place one handker- 
chief in a cravat 
around the neck, 
and knot its ends 
over the sternum. 
Place the other in a 
triangle under the 
forearm, so that 
its base may be 
next the wrist, 
then tie its angles 
to the cravat, and 



MINOR SURGERY. 



147 



carry the summit around the elbow to fasten to 
the body of the triangle in front. 

Use. — To support the forearm. This method of 
forming the sling is better than the common way, 
as the knots do not cut the back of the neck, owing 
to the position of the cravat, whilst the summit, 
being fixed at the elbow, keeps the arm more closely 
to the side of the body. 

ANTE-BRACHIAL TROUGH. 

Composition. — The trough may be either 
constructed of leather or pasteboard, which latter 
may be covered with some appropriate material 
with the view of preserving its form, and even giv- 
ing it a sort of embellishment ; and may be either 
straight, that is to say, open at the level of the 
elbow, or, as represented in the wood-cut, termi- 



nating there in 



i cul-de-sac : — a long riband or 



cord is required to serve for its suspension, and 
constitute two collateral bows, to which the author 
applies the term of arc- 
loops ; — lastly, a cravat. 
Application. — The 
cravat is arranged so as 
toconstitute a Cervical 
Cravat. Four holes 
being previously bored 
through the trough, 
at convenient distances 
apart, near its borders, 
the cord is then run 
through in order to form 
the arc-loops, which, in 
their passage, should be 
made either to glide through the Cervical Cravat^ 




148 



MINOR SURGERY. 



or, what is better, through a ring, as represented 
in the wood-cut, which serves to connect them, and 
allows of a free play of the loops, from which the 
patient will derive no small convenience. When 
the apparatus is thus prepared, nothing remains 
to be done but to introduce therein the patient's 
forearm, which has been, if fractured, previously 
furnished with its bandage. 

Observations. — This apparatus may be worn 
enclosed in the patient's ordinary dress, so as 
not to give the appearance of the arm being 
subjected to confinement. If, however, it be re- 
quired to preserve the elbow fixed against the 
trunk, a riband may be made to pass through 
a couple of holes perforated in the internal por- 
tion of the trough, or that which corresponds 
to the body, and to embrace the trunk as a 
belt or body-bandage. If it be necessary to give 
support to the hand or wrist, a thin, flat piece of 
wood may be laid at the bottom of the trough, and 
its projection beyond the end of the latter regulated 
by circumstances. 



Fig. 125. 




TRIANGULAR CAP OF THE SHOULDER. 

•Application. — Base of the triangle 
at the insertion of the deltoid mus- 
cle, or elbow, the summit over the 
acromion, and the angles carried 
round the arm, and tied on it as in 
the figure. 

Use. — To retain dressings to the 
round part of the shoulder or body 
of the arm. 



MINOR SURGERY. 149 



TRIANGULAR CAP : FOR THE HUMERUS AND ALL OTHER 

AMPUTATIONS. 

•Application. — The base of a triangle is to be 
conveniently placed under the limb, and at a con- 
venient distance from the extremity of the stump ; 
the tails are then to be brought forward and over- 
lapped, and the summit to be carried over the 
stump and fastened to the circular portion of the 
angles. In this last part of the process care should 
be taken that the linen embrace in the most per- 
fect manner the extremity of the stump, as shown 
under the head of dressings. 

Or, instead of commencing with the lateral an- 
gles, the summit may be first carried upwards in 
the manner described, and then the tails, in encir- 
cling the limb, may be made to include its extre- 
mity. 

Observations. — Whether employed in amputa- 
tions of the upper or lower limbs, of the fingers 
or toes, or even of the penis, nothing can be more 
simple or more effectual than this bandage. In 
general, no further precaution is necessary than to 
insist upon the patient remaining quiet ; for if the 
apparatus be carefully applied, there will be hardly 
a possibility of any derangement. But should it 
be absolutely necessary to have recourse to some 
expedient to prevent the apparatus from becoming 
detached, a cravat belt may be applied about the 
neck, or pelvis, the lower part of the arm, or thigh, 
the wrist, or ankle, according to the seat of the 
operation, and the limb may then be fastened to 
this by bands or tapes. 
13* 



150 



MINOR SURGERY. 



CARPO-OLECRANIEN. 

Application. — Fold two handkerchiefs into 
cravats, and apply one circularly around the arm 
above the elbow. Then tie one extremity of the 
other around the articulation of the carpal and 
metacarpal bones, so that the knot may come on 
the back of the hand, and attach the other extre- 
mity to the circular cravat, as in the arm of 
Fig. 119. (B.) 

Use. — To keep the forearm extended. When 
a splint is passed under each handkerchief on the 
front of the arm, it answers very well in the treat- 
ment of the latter stages of fracture of the olecranon. 



Fig. 126. 



FLEXOR OF THE WRIST. 

Application. — Place a cravat 
circularly round the arm above the 
elbow, and a triangle around the 
hand so that the summit may be 
folded round it, and fastened by 
one angle around the wrist. 
Flex the hand and forearm, and 
attach the other angle to the 
cravat on the front of the 
arm. 



CARPO-DORSAL, OR PALMAR TRIANGLE. 

Application. — Place the base of a triangle on 
the dorsal or palmar surface of the wrist, and 
carry the angles round this and the summit over 
the fingers, which are to be flexed, as in Fig. 127, if 
a dorsal handkerchief is wished. If not, slit holes in 




MINOR SURGERY. 



151 



Fig. 127. 




the handkerchief, as 
in the perforated T 
of the hands,andpass- 
ing the fingers through 
them, attach the sum- 
mits to the angles. 

Use. — To retain 
dressings to the back 
or front of the hand, or between the fingers. 

METATARSO MALLEOLAR CRAVAT. 

Application. — Place 
the body of the cravat 
obliquely across the in- 
step, and carry one ex- 
tremity round above the 
malleoli, the other round 
the sole of the foot and 
instep, to join it on the 
front of the ankle. 

Use. — To retain dres- 
sings to this part, as after 



Fig. 128. 




tying the anterior tibial. 

Where pressure is required, the spica of the instep 

should be substituted. 

TRIANGULAR CAP OF THE KEEL. 

Application. — Base to the sole of the foot directly 
under the instep, summit over one malleolus, angles 
crossed on instep, and then carried around the mal- 
leoli to confine the summit, as in the foot of Fig. 
129. (A.) 

Use. — To retain dressings to the heel. This is an 
excellent bandage in the treatment of the excoria- 
tions often consequent on the use of the extending 
band in the treatment of fractures of the thigh. 



152 



MINOR SURGERY. 



TARSO-PELVIEN CRAVAT. 

Application. — One circular cravat around the 
pelvis, the body of a second on the top of the foot, 
with one end tied under the sole, the other fast- 
ened to the pelvic band, as at B. 

Fig. 129. 




jj S6m — To support the limb and keep the foot 
extended, as in ruptured tendo-Achillis. 



MINOR -UKGERV. 



153 



( OMPOIXD METATARSO-ROTULAR CRAVAT. 

Composed of four cravats ; — a hollow paste- 
board or split deal splint; — some soft compresses. 

Application* — The patient's limb should be 
placed in the most complete extension, and the 
heel kept elevated above the level of the tuber- 
ischi by means of a pillow. The centre of the first 
cravat is to be applied against the anterior part of 
the thigh immediately above the patella, its extre- 
mities carried backward, crossed, and returned to 
the anterior part of the leg immediately below 
that bone ; by drawing on these, the two broken 
surfaces will be placed in tolerable apposition. The 
centre of the second cravat should then be applied 
against the sole of the foot, one extremity loosely 
knotted upon the metatarsus, and the other subse- 

*Yg. 130. 




quently carried upwards on one side of the knee to 
the supra-rotular portion of the first cravat, to 
which it is to be attached, as seen in the wood-cut. 
The sole of the foot here serves for a point d'appui; 
and this second cravat, aided by the respective po- 
sitions of the leg, of the thigh', and of the pelvis, 
tends to counterbalance the action of the extensors 
of the leg ; but, to obviate still more any possibi- 



154 



MINOR SURGERY. 



lity of flexion of the latter upon the thigh, which 
these cravats would not in all instances be enabled 
of themselves to counteract, recourse is had to a 
hollow splint, which is well lined with soft com- 
presses, and applied against the posterior surface 
of the limb. This is fastened in the simplest man- 
ner by the two remaining cravats. 

Use. — In fractured patella, incised wounds of 
the knee, &c. 

TARSO-PATELLA CRAVAT. 



Application. — One hand- 
kerchief in a cravat around 
the knee in a figure of 8, so 
as to embrace the patella, 
the middle of another being 
under the instep, and one end 
tied on the outside of the in- 
step, the other is passed 
under the cravat at the knee, 
as in the figure. 

Use. — In fracture of the 
patella. 



MALLEOLAR PHALANGIAL TRIANGLE, OR CAP OF THE FOOT. 

Application. — Base of the 
triangle under the instep, sum- 
mit over the toes, angles 
around malleoli to enclose the 
whole foot. 

Use. — To retain dressings 
to the foot. 





MINOR SURGERY. 



155 



TIBIO-CERVICAL 

Application.— Apply 

the body of a cravat to 
the shoulder opposed 
to the side affected ; 
bring down the tails 
obliquely to just above 
the crest of the ilium 
of the side correspond- 
ing to the injury, SO as 
to give it, when knot- 
ted, the appearance of 
a band. Then, flexing 
the leg to a right angle, 
apply a triangle to its 
anterior face ; the base 
corresponding to the 
ankle, and the summit 
to the knee; then carry- 
ing the tails, one along 
the inside, and the 
other along the outside 
of the thigh, attach 
their extremities, se- 
curely, to the cervical 
cravat, near the pelvis. 
Use. — To support 
the limb after the treat- 
ment of fractures of 
the leg, or in sprains 
where the patient is 
desirous of walking 
about. 



CRAVAT, OR SLING. 



Fig. 133. 




156 



MINOR SURGERY. 



Fig. 134. 




TIBIAL CRAVAT. 

Application. — Place the body 
of a broad cravat obliquely 
across the back of the leg, and 
carry one extremity round the 
leg below the knee, the other 
above the ankle to meet and tie, 
or pin on the front of the calf, 
or spine of the tibia. 

Use. — To confine sinapisms, 
blisters, &c, to the calf. The 
figure of 8 turns of this handker- 
chief prevent its becoming de- 
ranged by the movements of the 
patient. 



BARTON S HANDKERCHIEF. 

A very excellent method of making an extend- 
ing band for the treatment of fracture of the thigh, 
has been proposed by Dr. Rhea Barton, of this 
city. Dr. Barton was led to this application of 
the handkerchief by seeing how well the pressure 
of the boot on the heel and instep was borne, and 
how frequently excoriation and troublesome ul- 
ceration of the heel followed the use of the ordi- 
nary band or gaiter, which pressed directly on the 
sharp edge of the tendo-Achillis. With these 
views, he folded a handkerchief into a narrow 
cravat, and placed the body of it, directly on the 
extremity of the os calcis below the tendo-Achillis, 
so that two-thirds of the cravat came round under 
the outer malleolus, and the other third remained 



MINOR SURGERY. 



157 



on the inside. The inside portion remains parallel 
with the sole of the foot until the outside piece 
is carried over the instep and passed around it, 
forming a sort of knot, and also 
passed under the sole of the 
foot, to be turned around the 
first turn of itself, and form a 
knot at the metatarsal articu- 
lation, when both ends are car- 
ried off perpendicularly from 
the foot and fastened to the 
splint, the pressure coming 
directly on the instep and point 
of the heel, as seen in the Figs. 
When ulceration on the front 
of the ankle-joint, or on the 
heel, has been produced by 
the use of the ordinary means, 
this will be found to avoid 
the sore points, and yet keep up a permanent ex- 
tension. 

We have now given an account of the manner 
in which Mr. Mayor employs the handkerchief 
as a substitute for the ordinary roller ; and in order 
to preserve the continuity of his ideas, will here 
offer (what might perhaps with greater propriety 
come under another head) some of his remarks on 
the Hyponarthecia, or peculiar means of treating 
fractures, including a detailed account of his cli- 
nical frame, our wish being to offer as great a 
variety as possible of the means of treating surgical 
injuries, believing that each one will take from 
them what may be most desirable. 

" In 1S12 Mr. Sauter published, at Constance, a 
14 




158 MINOR SURGERY, 

work entitled * Instructions for treating safely, 
commodious!?/, and ivithovt splints, fractures of 
the extremities, particularly the complicated ones 
and those of the neck of the femur, by a method 
new , easy, simple, and economical? This work, 
published in German, was somewhat voluminous; 
and in order to render the subject matter more 
intelligible, M. Mayor translated freely whatever 
appeared to be the most prominent features of 
this novel invention, and published them in the 
work from which we have taken his system. Per- 
ceiving fully the advantages that might be deri- 
vable from the new system, he adopted it exclu- 
sively, and having submitted it to the test of four- 
teen years' experience and observation bath in the 
Hospital of Lausanne and in his private practice 
in the Canton, which was very extensive, he pub- 
lished, under the title o£"M£moiresur V Hyponar- 
thScie," the various modifications he hati deemed 
necessary, to give to this mode of treatment its 
greatest efficiency. His reasons for adopting the 
term Hyponarthecie (wo, under ; v*p9«|, splint) 
were based upon the fact that the planchette, or 
Schebmachine, or support of M. Sauter, upon 
which the limb reposes, was in itself a splint. This 
term is expressive of the system, and has there- 
fore been anglicised. 

" To set out, the problem proposed by M. Sau- 
ter, a problem so difficult that it almost seems a 
paradox, but which he has ably resolved, was " to 
treat a broken limb, ivith even the most serious 
complications, by position only, and without the 
use of splints ; and to permit the limb, at the 
same time, to execute, without pain or inconve- 
nience, every movement parallel to the horizon" 



MINOR SURGERY. 159 

Now, to effect this important object, recourse 
is to be had to a board properly cushioned, upon 
which the injured limb should be placed, and fixed 
in the position which it is necessary to give it ; 
the board thus charged, is attached to the ceiling 
or the top of the bed by means of cords, which 
are run through holes pierced in its borders and 
suspend it above the bed, so as to allow it a free 
horizontal motion. For the purpose of fastening 
the limb, two or three cravat-shaped ligatures are 
employed, which, in case of need, and with a cer- 
tain modification of this apparatus, namely, a foot- 
board or ladder, will equally serve for the execu- 
tion of traction or extension. But these ligatures, 
besides fixing the limb, exert a specific action 
upon the fragments themselves ; for, acting in 
contrary directions, they keep the fractured ends 
of the bone themselves, as well in juxtaposi- 
tion, asju the most complete immobility: so that 
this simple contrivance not only effectually pro- 
duces the necessary traction in the axis itself of 
the bone, but even similar tractions directly trans- 
verse to it; an advantage by which it is distin- 
guished above all other apparatus for fractures. 
This state of immobility is importantly seconded 
by the soft cushion, which, by moulding itself to 
the form of the limb, guarantees the security of its 
under part, or that which alone can be said to be 
excluded from the direct action of the transverse 
ligatures. 

But how, it may be asked, are the involuntary 
muscular efforts of the limb to be controlled? 
The answer to this is, that they soon terminate 
even under ordinary circumstances, and they do 
so in this case so much the sooner, as they are not 



160 MINOR SURGERY. 

stimulated and kept up by the weight or offensive 
pressure of ordinary apparatus. 

As the whole limb rests exposed to view, the 
inspection of the practitioner will discover at once 
the slightest possible displacement, which he will 
be enabled to remedy with the utmost facility ; at 
the same time that he may employ every kind of 
therapeutic agent in the event of injury of the 
soft parts. And the patients possessing, even under 
the most serious complications of their fractures, 
the faculty of horizontal motion, their beds can 
be easily made, and all the other necessary offices 
readily performed. 

Not the least advantage peculiar to this appa- 
ratus is its ready construction ; it may be made at 
all places and under any circumstances, even by 
the practitioner himself; for if, viewing the mate- 
rials in detail, some of these may not be at hand, 
such, for instance, as the pulley for the cords to 
run through, affixed to the ceiling, or the hinges 
necessary to a jointed board (see cuts), or a gimlet 
to bore the necessary holes, substitutes may be 
instantly found ; as, a staple for the first, a bit of 
strong leather for the second, and for the third, a 
few nails, by which the cords may be effectually 
fixed to the edges of the board. So also with re- 
spect to the cushion, how many substitutes may 
be found for this ! In short, whether a surgeon 
be called for, in scenes of the greatest poverty, on 
board ship with the fewest possible resources, or 
in the wildest districts, he need never be embar- 
rassed.* 

* On board ship it is especially serviceable, as the fracture 
is not easily deranged by the motions of the vessel, owing 
to the limb being allowed to swing as well as the body. 



MINOR SURGERY. 161 

The reduction of fractures, by the employment 
of this suspension apparatus, is effected thus. The 
board being furnished with its cushion, which 
should be sufficiently thick to constitute a soft 
bedding, and entirely cover it, and the vertical 
cord, forming a loop, properly suspended from the 
ceiling ; the second cord, destined to form the side 
loops, or arcs of the hoard, is to be run through 
the holes perforated through the angles of this, 
passing in its course through the first or suspen- 
sion loop, so as to be in readiness to comply with 
any exigencies, in regard to length, when the sus- 
pension is about to be effected. This done, the 
limb is made to glide along the cushioned board; 
and then the resistance, or counter-extension and 
traction, is resorted to, together with the coapta- 
tion of the fragments; and, by means of the trac- 
tion-bands, the position and coaptation of the frag- 
ments is fairly established. The ladder or foot- 
board, or extension band, will now keep the foot 
steadily fixed, white the due elevation given to the 
centre of the jointed board, if this be used, will 
constitute itanexcellentdouble-inclined plane, pos- 
sessed of all the advantages accorded to that species 
of apparatus. Lastly, the arc-loops and suspension 
loops are to be regulated so as to raise the limb 
to a proper height, which will be judged of by the 
surgeon, in consulting at all times, however, the 
feelings of the patient. 

As this kind of apparatus is in the way of the 
bed coverings, some little tact is requisite to over- 
come this trifling impediment ; but nothing need 
be observed on the subject here, as the good sense* 
of the practitioner will always readily suggest 
14* 



162 MINOR SURGERY. 

means to remedy an inconvenience so truly unim- 
portant. 

The use of the jointed board is strikingly evident 
in fractures of the femur, whether of its shaft or 
neck : it effects, in its quality of double-inclined 
plane, that which modern surgery only has suc- 
ceeded in obtaining ; namely, permanent Exten- 
sion^ joined to double Flexion, and the Fixing 
of the entire limb : but, besides this, suspension 
affords the utmost facility of motion in mass, by 
means of lateral action. It will be only necessary 
to observe this apparatus, as illustrated in the cuts, 
to be convinced how effectually the above import- 
ant objects are attained, and how totally impos- 
sible it must be for the fragments of the bone to 
ride in cases of oblique fracture, by reason of the 
powerful aid of the pelvic bandages. 

Even in fractures of the upper extremities, the 
hyponarthecic apparatus may be sometimes ad- 
vantageously employed ; as, for instance, where 
the fracture is one of very serious character, and 
complicated, with injuries of the soft parts, which 
requires that the patient should keep his bed, and 
which precludes, from what cause soever, the 
application of ordinary apparatus, as tending to 
aggravate his sufferings, and augment the difficul- 
ties of the case, In short, the only circumstances 
in which the invention of M. Sauter is contra- 
indicated, are those in which infants or maniacs 
are concerned, for reasons which the least con- 
sideration will render apparent. 

ANTE-BRACHIAL HYPONARTHECIA. 

Composition. — A board of convenient width^ 



MINOR SURGERY. 



163 



a little longer than the forearm and hand; — a 
cushion; — a cord for arc-loops; — and three 
cravats. 

Application. — The fracture being reduced, the 
forearm is made to repose on the cushioned board, 
a b, which is im- • 

mediately put into 
suspension to the 
patient's neck by 
means of the arc- 
loops, e e, ring, 
/, and Cervical 
Cravat, g. The 
second cravat, c, 
is now passed un- 
der the wrist and 
crossed upon the 
back of the hand, 
the tails being then 
made to embrace 

the cushioned board, and knotted at its anterior 
border, as represented in the woodcut. That done, 
the third cravat, d, is made to pass round the appa- 
ratus at its upper part, so as to confine the corre- 
sponding portion of the forearm, and be knotted 
also at its anterior border. Should it be deemed 
expedient, a fourth cravat may be made use of, to 
serve for a traction-band, which will of course 
be knotted at the inner border of the suspension- 
board. 

The advantages that may be derived from the 
hyponarthecic apparatus, may here be judged of; 
for in cases of fracture complicated with laceration, 
or other injuries of the soft parts, even occurring 




164 MINOR SURGERY. 

at the upper extremities, the wounds remain under 
the constant inspection of the practitioner, and are 
not subjected to the incommodious and even dan- 
gerous pressure of the common bandage, as 
must be the case when recourse is had to it under 
such circumstances. The patient may even be 
permitted, by the employment of this apparatus, 
to take exercise, when the injuries of the soft parts 
are not very grave ; but if, on the contrary, per- 
fect repose be deemed essentially necessary, in- 
stead of the above apparatus, a board should be 
procured, which, extending from the axilla to be- 
yond the finger's ends, should be well cushioned, 
and maintained in place by means of a Bis-axil- 
lary Cravat. The board may then be put into 
suspension. The above cravat may be adapted 
to suit the object in view in the following manner : 
— The centre of the cravat should be applied to 
the axilla of the sound side, its tails carried before 
and behind the chest to the opposite shoulder, 
crossed thereon, and then brought down, one on 
each side of the deltoid, to the upper part of the 
board, the extremities being made to pass through 
a mortise perforated in each board, in order to 
be knotted underneath. 

The bands for fixing, and the traction bands, 
may then be adapted according to the principles 
of the system. 

With respect to the suspension, in such a case 
it may be made either from the ceiling, or the 
top of an ordinary bed ; or if the hospital-bed 
be employed, as described hereafter, from the sus- 
pension-bar attached thereto. A precaution per- 
haps not unnecessary to be given, with regard to 



MINOR SURGERY. 165 

the cushion, is, that this should be of sufficient 
length to allow of its being turned downwards at 
its upper part, in order to protect the axilla from 
the pressure of the extremity of the board. 

This last apparatus will of course be equally 
applicable to fractures of the humerus, if compli- 
cated with severe injuries of the soft parts, but 
where a carved splint, as spoken of hereafter, can 
be obtained, it offers such advantages as must pre- 
vent frequent recourse being had to this of M. 
Mayor. 

HYPOXARTHECIA FOR THE TREATMENT OF FRACTURES 
OF THE LOWER EXTREMITV. 

This consists of a straight board, furnished with 
a cushion, and suspended, something in the man- 
ner of a scale-beam, from the ceiling or top of the 
patient's bed, by means of cords; its object being 
to give support to a fractured limb, and allow of 
lateral movement. 

The only thing which distinguishes this from 
other kinds of apparatus, is the suspension. The 
first thing to be shown, is the method of construct- 
ing it, and the advantages to be derived from its 
employment; the next, its adaption to the limb 
according to the nature of the injury. 

CONSTRUCTION. 

A thin board must be procured, proportioned in 
length and breadth to the size of the limb, as in 
Figure 137 ; it should be a trifling degree broader, 
and a few inches longer than the limb. Thus, for 



166 



MINOR SURGERY. 



Fig. 137. 



fractures of the leg it should 
extend from the bend of the 
knee to three or four inches 
beyond the heel. This board 
should be covered bya cushion, 
1 of its own magnitude, made of 

f , I oat-chaff, bran, cotton, hair, 

I tow, or, in short, of anything 

j J that could answer the same 

purpose, and be readily pro- 
cured: and it should have 
sufficient firmness to afford a 
plane of some resistance to 
the limb, and yet be capable 
of moulding itself exactly to 
its form. A hole is to be 
pierced near each of the angles 
of the board for the passage 
of the suspension cord, as 
at c. Each end of the cord is then to be intro- 
duced through the corresponding holes at one ex- 
tremity of the board from below upward, and after 
being drawn to the same length, passed from above 
downward through the holes of the other extre- 
mity, and firmly knotted. The cord will thus form 
two parallel bows of equal length, which, by being 
held at the middle, will suspend the board as a 
perfect plane, or allow of its receiving more or 
less inclination either way, according to the dis- 
tance, on one side or other of the centre, upon 
which the point of support is made to act. The 
support here spoken of consists of another cord, 
one end of which is to be carried through a staple 
driven into the ceiling, above the injured limb .nd 




MINOR SURGERY. 



167 



the other made to pass under the collected bows. 
By pulling, in contrary directions, the extremities 




of this second cord, the board may be elevated to 
the necessary degree ; and by knotting them, the 
elevation thus obtained steadily preserved. 

I tead of the staple, it is better to employ a 



168 MINOR SURGERY*. 

pulley, if it can be had, as seen in Figure 138. A 
pulley would likewise be found more convenient 
for the connexion of the perpendicular and trans- 
verse cords, as seen in the Figure at B. The first 
of these pulleys will afford greater facility in the 
elevation of the board, while the second will serve 
to give it the due degree of inclination, with but 
little effort, and without occasioning the slightest 
shock. 

As the free sliding of the cords would be detri- 
mental to the treatment of this case, from the cir- 
cumstance of the board being liable to alter its 
position by the least movement of the patient, it 
is advisable to tie the two bows together near the 
pulley, and introduce between the latter and the 
ligature a small splinter of wood, which will 
naturally prevent the bows from retrograding. 

These preliminary arrangements, with the ex- 
ception of the introduction of the splinter, or foot- 
board, should be made before the limb is placed 
upon the board, in order that it may be imme- 
diately elevated when the former is applied upon 
the cushions. Care also should be taken to arrange 
beforehand the patient's bed, by pressing it down 
at the part corresponding to the apparatus, in order 
that his horizontal movements may not be inter- 
rupted. As soon as the limb has been elevated 
to a certain height, it is advisable to place a pillow 
underneath the board, which should remain there 
till the fracture is reduced, and the position, &c, 
of the limb conveniently arranged. This appa- 
ratus, when isolated, yields to the slightest impulse 
imparted by the patient in his movements, without 
occasioning either shock or pain. 



MINOR SURGERY. 169 

The facility which patients have of moving 
themselves in this way is so great, that, as M. 
Mayor has remarked, they may be seen changing 
their position with the utmost facility, obeying, 
through means of the common utensils, the calls 
of nature, and even gliding upon another bed of 
equal height. 

Nevertheless, as may be readily conceived, it 
would be imprudent to permit them to indulge in 
any inconsiderate movements, as this would occa- 
sion and keep up in the osseous fragments a mo- 
bility that would become an obstacle to their con- 
solidation. When, therefore, it is found impossible 
to suppress the indulgence of such imprudent 
movements, the surgeon must have recourse to 
the bandage of Scuitetus, with the aid of splints, 
or else to the carved splint, to be spoken of far- 
ther on. 

It may thus be seen, that in fractures of the leg, 
where the suspension apparatus presents the most 
advantages, a simple board suffices if it extends 
from the bend of the knee beyond the heel. A 
simple board arranged in the same manner, and 
which, departing from the tuberosity of the ischium, 
would pass a few inches beyond the heel, would 
also be equally sufficient for a fracture of the shaft 
of the femur, if it was considered proper to place 
the limb in an extended position upon itsposterior 
face ; but for those surgeons who prefer the demi- 
flexion of the leg upon the thigh, and the latter 
upon the pelvis, the following apparatus becomes 
indispensably necessary. Two boards must be 
procured, the one precisely similar to that called 
tibial, of which mention has been already made, 
15 



170 



MINOR SURGERY. 



represented in Fig. 138; the other femoral ^s'm this 
figure, extending from the ham to the ischiatic 

Fig. 139. 




tuberosity, and articulating with the preceding, 
either by means of hinges, or simple tapes, which 
should pass through the holes with which the -ex- 



MINOR SURGERY. 171 

tremities of these boards are pierced, and be knotted 
underneath. The suspension of this double in- 
clined plane is effected in the same manner as the 
simple tibial board, with this difference only, that 
the two bows are extended from the superior ex- 
tremity of one of these boards, to the inferior 
extremity of the other. But in order to form the 
two inclined planes which are to support the limb 
in demiflexion, a small cord should be passed 
from below upward, through one of the holes of 
the upper extremity of the tibial board, as in the 
figure, across the point of support, and thence, 
from above downward, through the other hole of 
the same extremity, under which the two ends 
should be knotted together. In this way the ex- 
tremities of the two boards, corresponding to the 
bend of the knee, may be made to describe an 
angle, more or less acute, according as the limb is 
required to be placed in a greater or less degree 
of flexion. 

When position alone is sufficient to maintain 
the fractured extremities of the bone in apposition, 
and it is indispensably requisite to exert continued 
extension, or, in short, when more solidity is re- 
quired to be given to the apparatus, the femoral 
board should be shaped out at its internal and 
superior angle, and furnished with a belt, which 
will be spoken of farther on. 

The boards thus arranged, are not only useful 
in fractures of the shaft of the femur, but also in 
the treatment of fractures of the neck of that bone ; 
as they fulfil perfectly, in presenting two inclined 
planes for the flexion of the thigh and leg, the in- 
dication of the pillows of Sir Astley Cooper, and 
the machines of Sir Charles Bell, Earle, Del- 



172 MINOR SURGERY. 

pech, and Smith, of Baltimore, which have the 
inconvenience of being much more complicated, 
and consequently of less easy and general appli- 
cation, particularly in places distant from large 
towns. In short, one of the advantages for which 
the suspension apparatus is deserving of being 
made known, is its simplicity, and its possibility 
of being constructed at all times, and in all places. 
In country practice, says M. Mayor, in iso- 
lated districts, every portion of this apparatus 
may be readily procured without occasioning the 
least embarrassment to the surgeon. 

" For myself, I may say," continues this gentle- 
man, < C Y have never experienced the slightest 
difficulty. I have sometimes substituted any 
common bands, when the proper cords failed me ; 
I have nailed these to the board when I have had 
no instrument to bore the ordinary holes ; I have 
employed nails for screws, and to form the direct- 
ing bands, tow, wool, or rags ; these last materials, 
as also bran, sawdust, moss, and even soft hay, 
have served me in constructing my cushions for 
the boards ; the bark of a tree, moistened leather, 
the binding of an old book, have supplied the 
place of pasteboard ; and rope-ends, skin, or strong 
cloth, have not unfrequently replaced the metallic 
hinges." 

The double-boarded apparatus, it may be ob- 
served, will be found extremely useful in the case 
of fracture of the leg, with tendency to displace- 
ment, more especially when this occurs near the 
knee-joint, from the impossibility of applying the 
garter, (jarretiere,) one of the directing bands of 
which mention will be made farther on. 

Although particularly applicable to fractures of 



MINOR SURGERY. 173 

the limbs, the suspension apparatus of M. Mayor 
may, under other circumstances, be of important 
use. It will readily be conceived how great might 
be its utility in any painful diseases sealed upon 
one or other of the limbs, as well as in certain 
white-swellings, in arthritic and rheumatic tume- 
factions of the foot, or in any other serious affec- 
tions of the knee, or of the articulation of the foot 
and leg. Its use might be extended to the treat- 
ment of transverse wounds of the thigh, or of the 
tendo-Achillis, for which the most perfect immo- 
bility is indispensable. There cannot be a better 
means, so long as the immobility of the fractured 
part is insured, of allowing the patient to vary his 
position in bed. 

ADAPTATION. 

It is not sufficient, although assertions of this 
kind have constantly been made, to place a frac- 
tured limb, after its reduction, upon an immoveable 
plane, in order to effect the cure. If this were 
true, for very simple cases, which would be but 
exceptions, if, for instance, in the majority of cases 
of simple fracture of the femur, a convenient posi- 
tion and a retentive bandage might be made to 
replace all those complicated machines, which do 
more honour to the mechanical knowledge of their 
inventors, than to their knowledge of physiology ; 
it is not the less certain, that other means are re- 
quired also, to maintain the fractured extremities 
of a bone in perfect contact, to overcome the in- 
voluntary as well as the spasmodic contractile 
efforts of the muscles, and the indocility of the 
15* 



174 MINOR SURGERY. 

patient. But between these indications, and the 
necessity of violently extending in contrary ways 
the two extremities of a limb, by mechanical 
powers which resemble only the rack of the in- 
quisition, there is as wide a distance, as between 
the glossocome of the ancients and the simple pil- 
lows of Sir Astley Cooper : the surgeon who does 
not dare to expose himself to the dangers of the 
first, or to the insufficiency of the second, has re- 
course in cases to the extension apparatus of Des- 
sault and others, which are not, however, free 
from inconvenience, but more often to the sim- 
ple directing bands of M. Mayor, to which the 
only real objection that can be made is, that they 
are sometimes insufficient. 

In the greater number of cases of fractured 
limbs, the fragments face each other ; whence the 
necessity, of exerting pressure in the direction of 
their diameter, if the displacement exist in relation 
only to the axis of the body of the bone, or of pul- 
ling at the same time at the lower fragment, if the 
displacement is longitudinal, or in other words, if the 
broken ends overlap, in order to effect their coap- 
tation. The hands alone of the surgeon and assistant 
are sufficient to fulfil effectually these indications ; 
but as they are only temporary means, recourse 
must be had, in order to render the effects perma- 
nent during the whole time necessary to the con- 
solidation, to the aid of an intelligent machine, if 
such an expression may be used, which, in accom- 
plishing this end, will in no respect inconvenience 
the patient. 

Let the fracture of a leg be taken as an instance ; 
if it be of such a nature as not to exact the con- 



-UXOR SURGERY. 



175 



tinned extension of the limb, and position alone 
suffices to maintain the broken ends in apposition, 
the surgeon has only to confine himself to the ap- 
plication, below the knee, of a tie or garter, the 
central portion of which has merely to be applied 
upon the anterior, or one of the 'lateral faces of 
the limb, and its ends attached either separately 
on each side, or together, on the outside or inside 
of the board (A). The 



object here in view, 
as will be easily per- 
ceived, is to fix the limb 
upon the board and give 
a due direction to the 
superior osseous frag- 
ment. The garter, like 
all the other directing 
bands, may be made of 
a bit of common roller, 
or a longitudinal com- 
press, but M. Mayor 
prefers those he ordina- 
rily employs. These 
directing bands, the form 
of which may be seen 
in the figure, should be 
thick and soft, in order 
to preserve their shape, 
and prevent them from 
exercising a painful 
pressure. They should 
be constructed of two 
pieces of linen cloth, 
from three to five inches 



140. 




wide at the middle, with a layer of wadding, char- 



176 



MINOR SURGERY. 



pie, tow, or wool, interposed between them ; to 
the two extremities of these bands should be 
sewed tapes of convenient dimensions, or padded 
handkerchiefs will do as well. The figure indi- 
cate so clearly the man- 
ner of disposing them, 
that it is unnecessary to 
dwell upon them longer 
here : the place, how- 
ever, they are to occupy 
upon the limb, will be 
spoken of by-and-by. 

When these simple 
bands are found insuffi- 
cient to fix the limb 
solidly upon the board, 
or when it is necessary, 
in order to maintain the 
fracture reduced, to exert 
continued traction on the 
limb, the following pieces 
must be added. To the 
inferior extremity of the 
board above spoken of, a 
foot-support is to be 
adapted, of the shape. of 
a ladder, as in the Figure 
137, by means of mor- 
tises, a a, pierced in the 
it should be from eight to 
ten inches high, and form with the board an 
angle of about eighty degrees. 

The object of this foot-board is to fix the heel- 
strap or ordinary gaiter, which, on one hand, em- 
braces accurately the instep, heel, and malleoli, 




former to receive it 



KIHOl BURttMT. 177 

and on the other, is attached by means of the two 
tapes, which terminate it, to one of the sides of 

the ladder, according to the direction desired to 
be given t<> the limb. 

Thus, by means of the gaiter on one band, and 
the foot-frame and heel-strap on the other, the 
elongation of the limb may be produced, and the 
overlapping of the factured ends i lly pre- 

vented. The exteu ing made, is maintained 

by the heel-strap, and the counter-extension by 

the garter, or hand at the knee, without taking 

into account the weight of the body, and the fix- 
ture of the limb upon the apparatus; while the 
heel-strap, by fixing the foot, prevents rotation, 
inwards or outwards, of the lower fragment. 

But this alone is not sufficient to restore the 
limb to its natural form when the fragments are 
displaced m respeel to the diameter of the hone; 

and although the shortening of the hone has been 
provided against, nothing has yet been done to 

maintain the fractured ends in apposition. The 
following is the manner in which this indication 
is to be fulfilled ; instead of resorting, as is gene- 
rally the ease, to the uniform pressure exerted by 
the eighteen-tailed bandage, or that of Scultetus, 
with splints applied upon the soft parts that sur- 
round the ends of the bone, M. Mayor has recom- 
mended a means much more simple and more 
efficacious, and one which offers, besides, the ad- 
vantage of not covering in with the apparatus the 
part of the limb at which the fracture is seated; 
permits the surgeon also to visit it as often as he 
pleases, without the help of an assistant ; and to 
remedy the displacement, if any such should have 
occurred, as well as to dress the wound, should 



178 MINOR SURGERY. 

one exist, without meddling with the apparatus. 
The means in question consists in placing upon 
the part of the limb toward which the end of the 
bone is directed, and where it makes projection, the 
centre of a directing band, as in Fig. 140 (B) ; and 
fastening the extremities to the opposite side of 
the board ; care being taken, however, to see that 
the fracture is properly reduced. Two bands, 
which act in opposite directions, are occasionally 
necessary, but more frequently the desired effect 
is obtained by one alone. The middle of the 
band should be applied upon the most convex 
part of the deformed limb ; one of its extremities 
is to be passed immediately under it, the other 
over, and both drawn with sufficient force and 
fastened to a peg, inserted at the side of the board 
which corresponds to the concavity of the limb, 
or in default of this, to a mortoise pierced about this 
spot ; they may be even nailed at once to the board. 
The directing bands should not be placed until the 
heel-strap and garter are adapted, the latter being 
fixed to the board upon the opposite side to that to- 
ward which the neighbouring band 
l ^' * is to be directed ; without attending 

to this, the two extremities of the 
limb would be found to yield to the 
inverse tractions of the bands. The 
disposition of these several pieces 
is seen in the Figures 140,141. In 
comminuted fractures with ex- 
treme tendency to displacement, a 
piece of pasteboard should be ap- 
plied upon, the anterior part of the 
limb, as in Fig. 142, the notched 



illlr^N 

1 



III 

end being intended to touch the front of the foot 



MINOR ST7BGERT. 179 

To fix the femoral board more solidly, the sur- 

i should apply tl quilted band,or padded 

handkei . This band should 

be of sufficient length I belt round the 

body, and terminate by a strap, to I ed to a 

strap and buckle, fixed to tl stern rior 

>ard. This band >dy- 

bandage and perineal strap; it passes first of all 
upon the groin of the injur . then round the 

corresponding ilium and along the hack', and is 
returned over the pubes to the upper part of the 
fractured thigh, where the buckle, fixed to the 
outer Bide of the board, receives it, or where, when 
this is wanting, it may be ; ne other 

convenient point ofattachment. This belt, which, 
as may he pel , tends to fix securely the 

femoral hoard upon the pelvis, is employed with 
the notched portion of the board, against which 
the tuberosity of the ischium rests, to produce the 
counter-extension, or, in other words, ti. ince 

necessary to meet the tractions of the heel-strap; 
while the latter acts at the same time upon the 
limb which it elongates, and upon the hoard which 
it pushes upward, first beneath the ham and then 
upon the ischiatic tuberosity. Lastly, it is this 
portion of the apparatus wlueh performs the great- 
est part in the effort ; but as it is aided firstly by 
the weight of the limb, which, placed upon an in- 
clined plane, tends to descend, and secondly, by 
the effort itself, which tends to elevate the bend of 
the knee, there can be no reasonable apprehen- 
sion of the formation of sloughs or excoriations, 
such as the ordinary machines for continued ex- 
tension too frequently produce. 



180 MINOR SURGERY. 

This apparatus appears to unite all the qualities 
necessary for the reduction and consolidation of 
fractures of the neck of the femur. 

" To resume ; when it is required to maintain a 
reduced fracture of the femur, of whatever nature 
it may be, whether situated near the knee, or in 
the shaft or neck of the bone, whether simple or 
complicated, with or without obliquity of the 
fragments, the thigh and leg are to be extended 
over the inclined plane, well cushioned, the belt 
applied round the thigh and pelvis, and the foot 
attached to the ladder or foot-board inserted in 
the lower end of the tibial board. A large quilted 
band, or several handkerchiefs, embrace the whole 
apparatus to confine the limb upon the board, 
when there is no deformity ; or the bands of direc- 
tion, already described, made use of when the 
limb is curved, or there is any tendency to curva- 
ture."* 

With a view of raising patients in bed, when suf- 
fering from injuries to the lower extremities, Mr. 
Mayor proposes a Clinical Frame, which, from its 
simplicity, has many advantages over the compli- 
cated machinery of Earle, Jenks, &c, and may be 
advantageously used, especially by our army sur- 
geons, as it offers an, excellent bed, under even 
ordinary circumstances, being more steady, and 
not liable to the objections of an ordinary ham- 
mock. 

In speaking of it, he says : — It is, doubtless, 
highly gratifying to have at our service, as prac- 
titioners, a number of easy and convenient kinds 

* From ,s Nouveau Systeme de Beligatlon Chirurgicale" 



MINOR SURGERY. 1S1 

of apparatus, as well as appropriate and salutary 
therapeutic agents ; but there are circumstances in 
which, if we have the latter at command, the 
former are by no means so much in our power ; 
whence it happens, that we are occasionally called 
in, under circumstances so perplexing, nay, so 
truly desperate, that we are content with positive 
inaction, rather than allow our interference to add 
to the patient's sufferings. 

A large number of serious affections are daily 
met with Which not only compel the patients to 
keep their bed, but even place them beyond the 
possibility of being removed from one part of the 
bed to the other, without their being subjected to 
the most excruciating pain, or even to actual 
danger. Whether they repose then upon a bed 
of eider-down, or are stretched upon a hard pail- 
lasse, these unfortunate individuals soon experience 
the want of having their bed better arranged, and 
of being replaced in a position more supportable. 
They are excoriated at all those places where the 
bones project, as at the sacrum and the hips ; the 
skin, deprived of its subjacent fatty tissue, con- 
stantly and powerfully pressed against the bones, 
soon becomes irritated, and ultimately sloughs ; 
whence result those deep and extensive wounds, 
which, incessantly exposed to an invariable, and 
one might almost say corroding, pressure, to the 
difficulties attendant upon their dressing, and, still 
worse, to the continual contact of urine and faecal 
matter, sometimes finish existence of themselves, 
or rapidly abridge its duration. 

For the purpose of averting these serious incon- 
16 



182 MINOR SURGERY. 

veniences, various mechanical beds have been in- 
vented, the most ingenious of which tend to 
elevate entirely, and with great gentleness, the 
unfortunate sufferers whom it would be impossible 
to move with the hands or any other means, with- 
out occasioning the most heart-rending cries. 

It will readily be conceived, that the hands of 
one, two, or even three persons, are wholly insuf- 
ficient to support the entire body of an adult; that 
the parts which are not sustained must be put 
upon the stretch, while the others are pushed up, 
and that, from this unequal manner of action, the 
most excruciating pains ensue. And let it be, 
moreover, remarked, that the fingers do injury 
from their hardness; while, in addition to all this 
carrying to and fro of the body of the sufferer, the 
most disagreeable shocks are constantly occasioned, 
which infinitely augment his already intolerable 
pain. 

In point of fact, patients in general prefer sup- 
porting the whole of the serious inconveniences 
allied to their actually invariable and painful posi- 
tion, rather than expose themselves, by this lifting 
about, to absolute tortures ; more especially when 
this has to be effected frequently. 

Circumstances so melancholy have necessarily 
had the effect of awakening the solicitude of prac- 
titioners, the industry of patients themselves, and 
the compassion of those who are about them to 
contribute, if possible, to the palliation of such 
tortures, or at least to attenuate some of their more 
fatal consequences. 

But it has been more particularly in favour of 
the minority, that is to say, of the opulent, that 



MINOR SURGERY. 183 

such efforts have been crowned with success ; the 
lower orders of society still remaining without the 
pale of benefits arising from the invention of ma- 
chines calculated to be of avail in circumstances 
such as those just pointed out. The reason of this 
is evident ; the means indicated, and known under 
the title of Mechanical Beds, are so complicated 
and so costly, that they can only be within reach 
of persons in easy circumstances ; and even in 
hospitals, these beds are generally few in number, 
and their use very limited. 

So great, therefore, is the difficulty of obtaining 
these different kinds of apparatus, and still more 
the difficulty of adapting them to the exigencies 
of the most numerous classes of the community — 
classes which, be it observed, are the most con- 
stantly exposed to affections demanding contri- 
vances of this kind — that it has been of the ut- 
most consequence to consider other means, than 
such pieces of mechanism present, and to seek for 
what seems to have been, hitherto, wholly lost 
sight of, namely, a contrivance within the reach of 
every individual, and applicable in every circum- 
stance. This desideratum, M. Mayor thinks, will 
be found in his Clinical Frame, which he thus 
describes. 

The first things to be sought for, are two narrow 
boards or poles of about the length of the patient, 
and two crossbars of the same nature, of about a 
yard only in length. With these four pieces of 
wood, which may be easily united at their extre- 
mities by means of nails, rivets, bits of cord or 
handkerchiefs, we shall be immediately in posses- 
sion of a frame in all respects stout enough for the 



184 MINOR SUR £RY. 

end in view. It now remains to fill up the inter- 
mediate space ; and recourse must here be had to 
bands of webbing ; but if these should not be at 
hand, or at all events, should they be difficult to 
obtain, a few stout cravats would conveniently 
supply their place. Whether, then, the webbing 
bands or the cravats be employed, they must be 
arranged crosswise, fastened securely at their ex- 
tremities to the sides of the frame, and, above all 
things, possess sufficient strength to resist the 
weight of the patient when suspended in the air. 
Substitutes for the above materials may be equally 
found in towels, napkins, sheets, or indeed in any 
thing that would serve to constitute a bottom, soft, 
but yet sufficiently strong. After such simple data, 
it would be superfluous to point out how ingenious 
mechanics might modify the contrivance so as to 
prepare a frame more elegant, more in harmony 
with their own talent, their desire of gaining re- 
putation, or indeed with the fortune of those who 
employ them ; on the contrary, it would be ad- 
visable to urge the necessity of preserving the 
same simplicity in the construction of this, which 
will be found in the means destined to effect its 
elevation ; for there will be quite enough of those 
who are ever on the alert to throw a species of 
luxury about a machine, who will believe that 
they have perfected this, when, from a simple and 
effective instrument, they will have converted it 
into a complicated one despoiled of its best quali- 
ties. 

To raise the frame, as well as the patient, who 
is supposed to be stretched upon its bottom, it 
would be sometimes sufficient to employ two or 



MINI k SURGERY. 



185 



three dexterous persons, such as are met with in 
hospitals ; but in addition to the difficulty of find- 
ing such assistants, there will he always more or 
less inconvenience attending this operation when 
effected by the hands, in consequence of the shocks 
to winch the frame will be constantly subjected 
from the slightest deviation from a simultaneous- 
ness of action. It will, therefore, be found more 
convenient to have recourse to the means em- 
ployed in the hyponarthecic suspension, and to 
apply to the whole body that which so well suc- 
ceeds when applied to a limb. 

Thus, the four angles should be perforated with 
four holes, as in the Fig. 143, through which a 

Fig. 143. 




strong cord will be run in order to form two kinds 
of parallel bows or arc-loops of suspension; the 
16* 



186 MINOR SURGERY. 

one longitudinal, the other transverse 5 the former 
corresponding to the sides, the latter to the extre- 
mities of the frame. 

Recourse may be had also to one loop only, 
which will give to the frame the kind of tilting 
(jeu de bascule) observed in the beam of a scale. 
Movements of this kind are occasionally of im- 
portance, as when it is desired to raise the upper 
part of the body much above the horizon, or even 
the lower part alone. 

One strong vertical cord, firmly attached, and 
passing through a pulley, will suffice for the ele- 
vation of the frame charged with the patient, and 
must be arranged in the same manner as for the 
hyponarthecia of the extremities. Thus, in the 
dwellings of the poor, the ceiling is usually pro- 
vided with large beams ; nothing, therefore, will 
be found more easy than to arrange properly the 
staples or pulleys. Recourse may be equally had 
to a suspension bar of the kind represented in the 
figure, and placed at the head of the bed. But 
when these resources fail, or cannot be employed 
without some disadvantage, let that be remembered 
which is done by certain mechanics, particularly 
masons, when they desire to lift a heavy weight. 
The tripod, called generally the triangle, is the 
most easily constructed, the most firm, and in all 
respects the most convenient that can be employed 
for the object here proposed. This tripod, seen 
in the figure^ should have a pulley attached to the 
iron hook observed at its upper part, or point 
of union, in order to receive the vertical cord de- 
stined to raise the frame, and, thus provided, 
should be stretched across the bed. 



MINOR SURGERY. 187 

III order to render the ascent of the frame per- 
fectly gradual and easy, the vertical cord should 
be made to pass round a cylinder, fixed to two of 
the legs at their upper part, which may be turned 
either by a winch, or, if provided with holes and 
a small handle, as a capstan. 

Instead of this, if the free end of the vertical 
cord, after having passed through the pulley, be 
firmly secured to one of the legs of the tripod, the 
above effect may be accomplished by means of a 
strong stick, which is employed to twist the cord, 
and which, by shortening it at each turn, elevates 
the frame. 

But a still easier method is to employ a simple 
lever of the first power, — a pole, for instance, — 
whose fulcrum should be beside the bed, and to 
one end of which should be fastened the arc-loops 
themselves, as seen in the figure, or, what is still 
better, the vertical loop, which will permit, during 
its elevation, the frame to be better balanced : in 
lowering, therefore, the other end of the lever, the 
ascent of the frame may be regulated with pre- 
cision. The fulcrum, thus placed between the 
power and resistance, may be simply a rope's end 
made into a loop, and either firmly attached to the 
ceiling, or else to the tripod, which, in this case, 
instead of being stretched over the bed, should be 
placed beside it. 

With the ordinary hyponarthecic loops attach- 
ed to the Clinical Frame, which will allow of the 
point being varied where they are taken up by 
the vertical loop, we obtain, with the greatest 
facility, the power of elevating this frame in any 
direction we may choose, whether completely hori- 



188 MINOR SURGERY. 

zontally, or with an inclination towards either of 
its extremities or either of its borders; an advan- 
tage which will not be without its utility on parti- 
cular occasions. 

It will be hardly necessary to observe that, in 
order to obtain these effects, it suffices merely to 
place the vertical cord at the centre of gravity 
itself of the frame, or more or less beyond this, in 
the direction either of the head or feet, and to 
make, for producing lateral inclination, the arc-loop 
shorter on one side than on the other. The arc- 
loops, however, ought to be collateral, for all these 
little advantages would be far less easily obtained, 
were the cords, which perform the office of loops, 
placed transversely at either of the extremities of 
the frame. 

Like all frames destined for a clinical use, that 
just described may rest continually in place, in 
order that it may be raised at the moment desired, 
without previous preparation ; that is to say, the 
patient should repose upon the bottom itself of the 
frame ; or else this elevation may be applied at 
the instant only occasion may require it. In the 
first case, we should be careful that the bands or 
the pieces of cloth which constitute the bottom of 
the frame do not annoy the sufferer, and are pre- 
served as clean as possible. This will not be diffi- 
cult if preference be given to large pieces of stout 
cloth, which will occasion so much the less incon- 
venience, as they may be stretched at will, without 
forming any incommodious folds. 

It will be clearly seen, moreover, that, with this 
disposition, the surgeon may readily expose the 
ulceration, and manage the application of dress- 



MINOR SURGERY. 189 

ings, by displacing from the bottom of the frame 
that portion which otherwise masks the affected 
parts. 

When, on the other hand, it is found advisable 
to apply and elevate the frame several times, re- 
course should be had to the webbing bands, which, 
by means of a broad, thin, pliant piece of wood, 
may be glided, at the very moment, under the 
patient, much in the same manner as we should 
change the bandelettes in the apparatus of Scul- 
tetus. These bands, already attached to one side 
of the frame by one of their extremities, are then 
brought to the opposite side, where they are fast- 
ened, by means of their free extremities, through 
the intermedium of ribands, buttons, or buckles. 
This simple and easy means of gliding the bands 
under the patient, without at all incommoding 
him, and. thus interposing between the bed-clothes 
and himself some sort of bottom proper to sustain 
him when elevated, would naturally suggest a still 
more simple support, namely, cravats or oblongs, 
of whatever tissue they may be composed, or of 
whatever breadth it may be thought proper to 
afford them. The Clinical Frame may not only 
be regarded as a species of hyponarthecia, destined 
to sustain momentarily the entire body in any 
manner, or in any direction desired to be imparted, 
but, being moveable, it will be seen to offer one 
very precious resource in a circumstance of the 
most important nature. Allusion is here made 
to the frightful sloughing sores common to the 
lower and back part of the body, and which 
the pressure against the bandelettes renders in- 
supportable, and tends constantly to exasperate. 



190 MINOR SURGERY. 

Many are the means, without doubt, employed to 
attenuate this horrible pressure ; yet they not only 
most often fail, but are difficult to procure, to 
maintain in place, and preserve in a proper state 
of cleanliness. The Clinical Frame, then, with 
very little additional trouble, averts this inconve- 
nience in the following manner: — 

Let the individual be extended over the bands 
placed transversely behind his back, and let us 
suppose that these bands are properly stretched 
from one side of the frame to the other ; it is clear 
that the poor sufferer will press upon them all with 
his entire weight. But if we detach those bands 
which correspond to the ulcerations, and if, at the 
same time, we remove sufficient of the hair, wool, 
or straw of the mattress which exists under the 
bands we have just placed aside, we shall imme- 
diately obtain a sort of hollow or depression, in 
which the ulcerated surface will be but very slightly 
touched. It will be even possible to afford such 
depth and extent to this depression that the af- 
fected parts remain, as it were, in the air, in a com- 
plete state of isolation. In short, the bands, placed 
above and below the seat of ulceration, will sus- 
tain the body with great exactness, and will leave 
the sore open, and at that degree of elevation 
which may be judged necessary, to subtract it 
more or less, from the pernicious influence of the 
pressure we are striving to avoid. 

It may be, however, observed, that, instead of 
the excavation already spoken of, the mattress 
may be cut across, and of one mattress two smaller 
ones formed, which may be placed so as to allow of 
a sufficient space between them to guarantee the 
wound from pressure, according to its extent. 



MINOR SURGERY. 191 

The Clinical Frame may, in campaign, admi- 
rably serve for a litter, for the transport of the 
sick or wounded ; it possesses the advantage of 
the most simple form of construction, and of being 
made of materials to be found on all occasions. 
In this case, instead of webbing or other bands, to 
form the bottom of the frame, recourse may be 
had to simple cords covered with hay, straw, 
leaves, grass, pieces of clothing, &c. When it is 
found necessary to have the litter stationary, no- 
thing would be more easy than to adapt to it a 
tripod or triangle, which would possess two re* 
markable advantages ; firstly, in forming solid 
feet for the support of such temporary bed ; and, 
secondly, in forming a frame proper to receive a 
blanket, or something of the kind, to serve for the 
purpose of a curtain and to protect the sufferer 
from the sun, rain, wind, &c. 

Many other occasions might, doubtless, be 
found for the use of this frame when put into 
suspension. Serving as a sort of hammock, it 
would seem to invite officers to establish it under 
their tents, and would guarantee them from the 
humidity of the ground, from insects, and other 
annoyances inseparable from a bed placed directly 
upon the earth. The same may be said of it in a 
bivouac, where the triangle need only be covered 
by a cloak. 

The suspension-bar, as seen in Figure 143, 
adapted to a common hospital-bed, has been al- 
ready pointed out as a means of establishing the 
suspension of a hyponarthecic apparatus : it re- 
quires no description, for the drawing will suffice 
to give the most correct idea of its construction. 



192 MINOR SURGERY. 

It will be seen therein to represent, however, only 
one-half of it, as the drawing of the other half 
would have interfered with the view of the tri- 
pod.* 



PART THIRD. 

OF THE APPARATUS FOR THE TREATMENT OF 
FRACTURES AND DISLOCATIONS. 

SECTION FIRST. 

OF THE TREATMENT OF FRACTURES. 

The proper treatment of these injuries is one 
of the most important parts of the surgeon's duty, 
and one from which no practitioner can escape, 
as not to be able to set a broken limb or reduce 
a dislocated bone, is enough to destroy entirely all 
professional reputation, the public not being able, 
generally, to understand the distinction drawn 
between the duties of the surgeon and those of 
the physician. Yet important as the subject un- 
doubtedly is, it would be foreign to a work of this 
kind to treat of it in all its bearings ; to consider 
its causes or its physiological and pathological 
changes ; and I shall, therefore, confine myself to 
the consideration of such points as are connected 
with the treatment, briefly hinting at the views of 

* From Mayor's " Nouveau Systeme" etc. 



MINOR SURGERY. 193 

the different schools, and refer those who wish 
for a more minute knowledge of it, to the many 
articles on the subject to be found in all our works 
on Surgery. 

The first part of the treatment is included in 
the different means of reduction by extension and 
counter-extension. Here there is considerable 
diversity of opinion, each being sometimes right 
and sometimes wrong: thus, the French sur- 
geons apply the extending force to that part of 
the limb which is articulated with the lower end 
of the bone, and the counter-extending force to 
that which is articulated with the upper ; their 
object in not applying these forces upon the frac- 
tured bone itself, being to avoid such an irritation 
of the muscles, as might cause a spasmodic con- 
traction and impede the efforts at reduction ; thus, 
in fractures of the thigh, their means of extension 
act upon the lower part of the leg, and those of 
counter-extension upon the pelvis ; whilst the 
doctrines taught in the English schools, inculcate 
as a leading principle the necessity of putting the 
limb in a flexed position, or one capable of relax- 
ing the more powerful muscles connected with the 
fractured bone, and of employing the extending 
and counter-extending forces so as to act upon the 
bone itself. This, however, was found defective in 
the reduction of some broken thighs, and preference 
was given to the former method. Other excep- 
tions are also to be found to this plan of reduction, 
where, for instance, the application of the means of 
reduction at a distance from the affected part, is ne- 
cessitated by the peculiar disposition of the part 
itself; thus, in fractures of the clavicle, the exten- 
17 



194 MINOR SURGERY. 

sion must be practised upon the arm and shoulder, 
and the counter-extension upon the trunk. Nor 
is the French mode, above mentioned, capable 
of universal application, as is seen in fractures of 
the lower jaw; extension in these cases being 
only made properly upon the bone itself. There 
are fractures, also, in which no extension is neces- 
sary, coaptation alone sufficing, the displacement 
being due to the external cause which produced 
the accident ; such, for example, are those of the 
bones of the head, the nasal bones, the ribs, &c. 

The direction in which extension is to be em- 
ployed, is to be regulated by the displaced frag- 
ment itself; thus, in oblique fractures of the hu- 
merus, if the lower fragment mounts on the inside, 
the extension must be made obliquely downwards 
and outwards, then downwards, in order to restore 
it to its natural position, and the degree of force 
necessary to be employed is not appreciable, ct 
priori, as it must always be in relation to the kind 
of displacement and to the resistance of the mus- 
cles of the part. When sufficient extension has 
been made, the broken ends of the bones are to 
be placed in their natural situation by the fingers, 
or, as is said,coapted ; and the surgeon proceeds by 
acting upon the lower fragment, if in fractures of 
the limbs, to regulate their contact. Should he, 
however, deem it indispensably necessary to apply 
his fingers directly on the fracture, he should do 
it as lightly as possible, to avoid pressing the soft 
parts against the splinters, as this will cause spas- 
modic displacement. 

With respect to the means of keeping fractures 
reduced^ it is to be first observed that a multiplicity 
of causes would tend to disconcert the coaptation 



MINOR SURGERY. 195 

of the fragments, were not effectual means re- 
sorted to by the surgeon for rendering them im- 
moveable by the use of appropriate apparatus. 
Nor is the position of the part and even of the 
whole body a thing of small importance. " The 
most favourable position," says Professor Cooper, 
" for a fractured limb, is that in which all the mus- 
cles passing over the fracture, and extending either 
to the lower fragment or to that part of the lirnb 
which is articulated with it, are equally relaxed ; 
the injured limb should also have a firm support 
at every point, and its position ought to be so re- 
gulated, that not only this object should be care- 
fully fulfilled, but at the same time the chance of 
displacement from the action of the muscles, or 
the weight of the body or part itself, may be di- 
minished as much as possible." The bed on 
which a patient ought to be placed, who is labour- 
ing under a fracture, should be narrow, so as to 
allow of the surgeon getting conveniently at the 
limb : and the patient should repose upon a mat- 
tress, and never on a feather-bed. Boyer recom- 
mends, as the best pillow for supporting a broken 
limb, one stuffed with oat-chaff; as he considers 
it less heating than a pillow of feathers, and also 
less apt to soil. 

Dessault and Boyer recommend, in fracture of 
the thigh-bone, keeping the limb in a straight pos- 
ture ; and of the various apparatus invented for 
the purpose, those of these distinguished surgeons 
are perhaps of all others the best calculated to fulfil 
the indications proposed by this method of treat- 
ment. Pott considered the best position to be that 
in which the limb is laid upon its outside with the 
knee bent, the fractured bone resting on the great 



196 MINOR SURGERY. 

trochanter, while the leg and foot are supported 
by smooth pillows* and slightly elevated. Con- 
siderable objection has of late years been made to 
Pott's method, principally on account of its leav- 
ing the lower part of the limb too moveable and 
unsupported, and imperfectly fulfilling the pro- 
posed indication, namely, of preventing disturb- 
ance of the coaptated fragments. Sir Charles Bell 
prefers placing the patient upon his back, and sup- 
porting the limb upon a double inclined plane, a 
machine constructed for this purpose, and consist- 
ing of boards ten or eleven inches wide, one of 
which reaches from the heel to the ham^and the 
other from the ham to the tuberosity of the ischi- 
um ; these are united at the knee-joint by hinges, 
and their lower ends are fastened together by a 
horizontal board, cushions being placed upon the 
whole, and the limb left in a bent position. After 
the fracture has been reduced, a long splint is ap- 
plied from the hip to the knee, and another along 
the inside of the thigh : and the lower part of the 
apparatus is furnished with a foot-board to prevent 
the foot from being turned outwards, and also to 
keep the limb steady. 

Each of these methods has its partisans, but the 
general opinion here is decidedly in favour of Des- 
sault and Boyer. 

Whatever be the opinion of writers on these 
points, let it be recollected that the grand points in 
the treatment of fractures, are the reduction, and 
coaptation of the fragments, and the employment 
of some means to keep them in their proper posi- 
tion when thus reduced, and that with this view 
some one or more of the parts composing the dif- 
ferent Apparatus for Fractures must be employed. 



MINOR SURGERY. 



197 



These consist of Splints, Cushions, or Junk-bags, 
Pads, Extending and Counter-Extending Bands, 
Palettes, or Hand Splints, Soles or Foot-Splints, 
Compresses, Pads, Slings, and Rollers. The mi- 
nute directions for the preparation and applica- 
tion of each of which, will be given in connection 
with the treatment of the particular fracture for 
which they are required. 

FRACTURES OF THE SKULL. 

Here the dressing will depend on whether or not 
it has been necessary to trephine. But in any case 
where it is requisite to retain dressings to the cra- 
nium, we may resort to the Recurrent Bandage of 
the Head, the Single or Double T ; the Handker- 
chiefs of Mayor ; the Bandage of Galen, or to the 
Sling of Four Tails. 

FRACTURE OF THE BONES OF THE NOSE. 

After the fracture has been reduced by the use of 
a probe introduced into the nostril to elevate the 
bones if they have been depressed, we may em- 
ploy the Double T of the Nose, to retain the dress- 
ings to the part, or to the internal angles of the 
eyes, and thus combat the inflammation of the 
nasal duct which so often supervenes. 

IN FRACTURES OF THE LOWER JAW, 



Fig. 144. 




Anterior to its angle, we may 
employ Dr. Barton's Bandage, 
with the use of a pasteboard 
splint, as in the figure, or the 
Sling of the Chin, or the Band- 
age of Dr. Gibson, which is 
composed as follows : — 



198 



MINOR SURGERY. 



gibson's bandage for fracture of the jaw. 

Composed of a roller, five yards long and two 
inches wide, and of a compress and splint, if ne- 
cessary. 

Application. — After having carefully examined 
the injured parts, and replaced any of the teeth 
that may have been deranged, we should run the 
fingers along the margin of the jaw, in order to 



Fig. 145. 



mould it into its proper 
shape. Then closing 
the mouth firmly, make 
the lower teeth press 
fairly upon the upper, 
and place a compress 
of moderate thickness 
under the fractured por- 
tion, where it should be 
held by an assistant. 
The surgeon next takes 
the single-headed roller, 
and commencing on the 
top of the head, passes 
it by several turns down the side of the face under 
the jaw, and over the compress ; after the third 
turn of this kind make a reverse on one temple, 
so as to run off perpendicularly and surround the 
forehead and occiput by circulars of the vault of 
the cranium. On the third of these turns pass 
from the occiput obliquely oyer the back of the 
neck, and under the ear, to make three circulars of 
the chin and neck ; from the neck pass obliquely 
upwards to go circularly round the forehead, and 
place pins at each turn. If the turns are likely to 
slip, fasten a small strip on the forehead, and carry 




MINOR SURGERY, 199 

it over the vertex to fasten it to the turns on the 
neck, and 'thus secure, them more perfectly, as 
seen in the figure. 

During the treatment of fracture of the jaw, the 
patient must be fed on soft, semi- liquid food, and 
not allowed to speak ; but there is no occasion for 
inserting a piece of cork between the teeth, or 
drawing any of them, as there is usually enough 
space between them as they stand to enable any 
one to suck food through them. This fracture, 
under favourable circumstances, consolidates in 
four or six weeks, but the patient should not eat 
hard or tough articles for some weeks afterwards, 
for obvious reasons. 



FRACTURES OF THE VERTEBRAE, 

Require no apparatus. Our attention must here be 
mainly directed to the use of the catheter and of ene- 
mata, the use of which will be treated of hereafter. 
An important point to be recollected in these injuries 
is, not to turn the patient on his belly in order to 
examine the back, but to turn him only on to his 
side ; for as the abdominal and intercostal mus- 
cles may be paralysed by the injury, the diaphragm 
alone can act in respiration, but, in order that this 
may descend, the abdomen must bulge out, so as 
to allow of the descent of the bowels and expan- 
sion of the chest. If, then, the patient is kept for 
a length of time on his belly, there is not sufficient 
force in the diaphragm to do this, as it has to over- 
come the resistance made by the weight of the 
body on the bed — consequently, if the examina- 
tion is tedious, the patient will run the risk of being 
suffocated. 



200 MINOR SURGERY. 

FRACTURES OF THE STERNUM. 

The indications here are, to prevent deformity 
from the projection or depression of the fragments, 
and also to keep the chest at rest, and oblige the 
patient to breathe by the diaphragm and abdomi- 
nal muscles. These may be very well fulfilled by 
placing a compress over the part, and confining the 
chest by the Crossed Bandage, or by the Spiral of 
the Chest , as has been before shown. 

FRACTURES OF THE RIBS, 

Are to be treated on the same principles, the com- 
presses being over the parts, if the fragment projects 
externally, but over the end of the rib, if they are 
depressed. These compresses and the whole chest 
are to be confined by the Spiral Bandage of the 
Chesty Fig. 42, which should be drawn very tight. 

FRACTURES OF THE PELVIS, 

Require no other apparatus than a broad band- 
age of the abdomen and pelvis, there being here 
little or no tendency to deformity, owing to the at- 
tachment of muscles. 

FRACTURES OF THE CLAVICLE, 

Are treated by several kinds of apparatus, but all 
having for their object the keeping of the shoulder 
upwards, outwards, and backwards. It is necessary 
that it should be kept upwards, to bring the frag- 
ments on the same level, outwards, to preserve the 
proper length of the clavicle, keep the arm at its pro- 
per distance from the sternum, and preserve the pec- 
toral space, and backwards, to bring the bones into 
the proper line in front. The first means to be 
shown of doing this, is the old and widely known — 



MINOR SURGERY. 



201 



Fig. 146. 



APPARATUS OF DESSAULT. 

This is Composed of three single-headed rollers, 
eight yards long and two and a half inches wide, 
of a pad of the length 
of the humerus, and 
four inches thick at its 
base, made in the shape 
of a wedge by folding 
muslin on itself, so as 
to form a compress 
graduated from one 
end, as before shown, 
and then covered with 
a piece of muslin, — of a 
compress to go over the 
broken bone, of a short sling to support the fore- 
arm, and of a piece of muslin long enough and 
wide enough to surround the chest, arm, and ban- 
dage, and keep the whole in its place. 

•Application. — These being prepared, and the 
patient either seated on 




a chair or bench, with 
out a back, or else stand- 
ing, an assistant is to 
elevate the arm of the 
injured side, and carry 
it off at right angles 
to the body, whilst the 
surgeon places the pad 
in the axilla, the thick 
end upwards, where it 
is to be held by the as- 
sistant. The initial end 
of the first roller is 



Fig. 14" 




202 



MINOR SURGERY. 



then placed on the middle of the pad, and two or 
three circular turns of the chest are made, when 
the roller is to be carried up over the front of the 
thorax, over the sound shoulder, under this arm- 
pit to make a semi-circular turn on the front of the 
chest, over the pad round on the back, over the 
sound shoulder, under the arm-pit,and then spirally 
around the chest. (Fig. 147.) The object of this 
roller is merely to fix the pad. 

The surgeon then flexes the forearm on the arm, 
and bringing it down along the pad, presses its 
lower extremity forcibly against the side of the 
chest. This, by forcing the shoulder outwards, 
draws the clavicle to its original length ; for the 
humerus being thus made a lever of the first kind, 
its upper end is drawn from the shoulder in pro- 
portion as the lower end is forced against the 
thorax. He at the same time directs its head up- 
wards and backwards, and thus immediately re- 
duces the fracture, an assistant holding it so until 
the next two bandages are applied. These are 

intended to keep the 



Fig. 148. 




fracture reduced. With 
this view, place the 
commencement of the 
second roller in the 
axilla of the sound side^ 
carry it across the breast, 
over the upper part of 
the arm of the injured 
side, and obliquely 
round the back to the 
axilla whence it started, 
and continue these turns 
down the arm to the 



MINOR SURGERY. 



203 



upper part of the forearm, drawing them gently at 
first, and gradually tightening them as they ap- 
proach the elbow, so as to force it well inwards, 
(Fig. 148.) 

The object of this roller is to carry the shoulder 
and head of the humerus outwards by pressing the 
elbow inwards. In order now to keep the shoulder 
upwards, the third roller is to be placed at the 
sound axilla, passed obliquely over the front of the 
chest to the fracture, where a compress is placed, 
then over this and down the back of the arm to 
the elbow, thence obliquely upwards to the front 
of the sound axilla, under this obliquely upwards 
over the back, over the fracture, down the front of 
the arm to the el- 
bow, and thence ob- Fig. 149. 
liquely to the back 
of the sound axilla, 
under this to its 
front part, over the 
chest and fractured 
bone, to run the 
same course, and 
end by circulars of 
the chest, which fix 
the whole. These 
turns form a kind of 
double triangle, one 
of which is before 
the breast, the other 
on the back, and are the only difficult ones to re- 
collect. But when we remember that starting 
from the sound axilla, it is to go over the fracture 
down the arm to the elbow, and from the elbow 
always to the axilla, there will be no difficulty 




204 MINOR SURGERY. 

in its application. After this, it remains only to 
support the forearm by the sling, and cover the 
whole apparatus by the piece of muslin before 
spoken of, in order to prevent the turns of the 
roller from slipping. 

The principles upon which this bandage acts, 
namely, by converting the humerus into a lever 
of the first kind, by carrying its lower extremity 
forwards, inwards, and upwards, thus pushing the 
shoulder backwards, outwards, and upwards, 
renders it exceedingly well adapted to fractures 
of the clavicle. The pad placed in the axilla serves 
as the fulcrum ; and one of the great advantages 
of the apparatus is, that it may be readily con- 
structed. It is liable, however, to some objec- 
tions ; thus, for instance, the compression which 
it exerts about the chest, renders it ill adapted to 
females or patients of a delicate constitution, and 
is also very heating in warm weather, and re- 
quires to be taken off and reapplied at least every 
two or three days, from the circumstance of its 
becoming easily displaced by the movements of 
the patient, especially if it is in a child, and the 
pressure, too, of the axillary nerves and bloodves- 
sels, from the too great tightness of the second 
roller, often causes great pain and inconvenience 
to the patient. 

BARON BOYER's BANDAGE FOR THE SAME. 

Composed of a wedge-shaped pad for the axilla ; 
— a belt of webbing or of linen, about five inches 
wide, and quilted to surround the trunk, closing 
at the ends by means of straps and buckles ; a cir- 
cular band for the arm, constructed of the same 
materials as the belt, and to lace in front : four 



MINOR SURGERY. 



205 



straps attached to this, two on each side, near the 
uniting edges, and to correspond with these, four 
buckles fastened upon the belt, two before and 
two behind the arm, complete it. 

Application. — The pad is placed in the axilla, 
and its bands carried 
one before and the Fig. 150. 

other behind the 
chest to the opposite 
shoulder, and tied : 
the belt is then pass- 
ed round the body, 
beneath the pad, 
and a little above the 
bend of the elbow, 
and buckled poste- 
riorly. Next, the 
circular band is laced 
upon the arm, and 
confined to the trunk 
by means of the 
straps and buckles of 
the same ; a sling or 
band is sometimes 

added. While the elbow is thus fixed firmly to 
the side, the pad tends by its resistance to push 
the superior part of the arm outwards, and the 
elbow may be moved either forwards or back- 
wards by merely tightening the anterior or poste- 
rior straps, and the shoulder thus carried in op- 
posite directions. 

This bandage, acting upon the same principles 
as that of Dessault, is preferable to the latter only 
from the circumstances of its not being liable to 
18 




206 



MINOR SURGERY. 



become displaced, and by its causing a more limit- 
ed compression of the chest ; this compression 
being capable of being regulated by means of the 
straps and buckles which unite the ends of the 
belt. 



MAYORS HANDKERCHIEF BANDAGE FOR THE SAME. 

Composed of two large handkerchiefs, or pieces of 
strong linen of the same form, one folded in trian- 
gle, the other in a broad cravat ; — a cushion for 
the axilla ; — and a soft pad for the opposite 
shoulder. 

Application. — First, the cushion, a, is to be 
placed in the axilla, and the arm put into the pro- 
per position, with the forearm bent ; the doubled 
edge of the handkerchief, 6, folded triangularly, 
being made to envelope the elbow by its summit, 
while the angles support the hand ; the poste- 
rior angle is then 



Fig. 151. 




carried up under 
the axilla and be- 
hind the back to 
the opposite shoul- 
der, upon which the 
pad or compress, 
c, is previously 
placed, and the an- 
terior one brought 
up in front to meet 
it and be tied. 

The second hand- 
kerchief, rf, in cra- 
vat, serves to con- 
fine the elbow and 



MINOR SURGERY. 207 

forearm more securely by being carried round the 
waist, and fastened upon the opposite side of the 
trunk. 

Mayor modifies this bandage in the following 
manner when intended for fracture of the acro- 
mion : after the first handkerchief or sling is ap- 
plied, some compresses should be placed upon the 
injured shoulder, and a few vertical turns of a 
roller passed round the shoulder and elbow, as in 
the third roller of Dessault ; after which, the second 
handkerchief is to be applied as above ; the cush- 
ion under the axilla should also be omitted, and 
a compress substituted, before applying the first 
handkerchief, between the elbow and side. 

This mode of treating fracture of the clavicle 
answers very well as a provisional dressing, and 
better than the ordinary sling, but where the other 
means can be obtained, a more perfect cure will 
more certainly be accomplished. 

APPARATUS OF DR. FOX. 

Composed of a stuffed collar, a small pad, an 
elbow-piece, and a little sling for the forearm. 

The collar is made of a piece of four-inch mus- 
lin, sewed together on its sides, stuffed with 
cotton, and then joined at its ends. The pad is 
wedge-shaped, and like Dessault's, except that it 
is not so thick or so long, being merely intended 
to fill up the space between the arm and the side ; 
two tapes are attached to its thick end, to fasten 
it to the collar. The elbow-piece is made of 
strong muslin or brown holland, like half of the 
sleeve of a coat, and embracing the elbow, mounts 
half way up the arm, and extends to near the 



20S 



MINOR SURGERY. 



Fig. 152. 



wrist. To its upper and lower or posterior ends, 
are attached two pieces of broad tape, long enough 
to reach across the back to the collar, and to its 
front are two loops to receive a tape for the front. 
application. — Place the collar on the sound 
shoulder, the pad in the injured axilla, and fix it N 

there by carrying its 
tapes one in front of, 
the other behind the 
chest, to tie them on 
the collar. Flex the 
forearm, place the 
elbow-piece on it 
and the arm, and 
bring the arm against 
the pad. Fasten the 
posterior tapes to the 
collar behind ; and 
running the tape or 
band through the loops near the wrist, tie the fore- 
arm well up to the collar in front. This reduces 
the fracture completely, and is all that is generally 
required. 

Observations. — Of all the means recommended 
for the treatment of fracture of the clavicle, none 
are more simple or better to fulfil, the indications 
than this of Dr. George Fox. Made in a few 
minutes of materials nearly always at hand, re- 
ducing the fracture, yet leaving it open to inspec- 
tion ; light and easy of application ; producing no 
constriction of the chest, pressure on the mammae 
or on the axillary vessels or nerves, it offers ad- 
vantages that no other means possess; and Dr. 
Fox, by its introduction into practice, has caused 




MINOR SURGERY. 209 

the perfect cure of very many cases, and saved the 
patients much unnecessary suffering and incon- 
venience. In the Pennsylvania Hospital it is the 
only means employed for the treatment of this 
injury, and repeated testimony has been given of 
its ability to produce perfect cures, it being a rare 
thing for a simple case of this fracture to go out 
of the house with any deformity save that which 
time cures, viz., the deposition of the provisional 
callus. From 1829 up to the year 1838, a period 
of nine years, seventy-five cases of fractured cla- 
vicle were treated in the house, of which, sixty- 
three were discharged cured, and twelve left the 
house while under treatment, the apparatus allow- 
ing of their walking about as usual.* In thg sub- 
sequent years a large number of cases have also 
been treated with such success, 4hat no one who 
has employed it ever resorts to any other means 
of treatment, except in special cases, where an ad- 
ditional bandage, as a posterior S, &c, may be 
added. Whenever there is any derangement of 
the fracture, it is only necessary to tighten the an- 
terior or posterior tapes of the sling in order to 
remedy it. Its use is highly recommended, by a 
weight of surgical authorities, and by the simpli- 
city and facility of its application. The effect 
produced on the bone by this apparatus, is well 
shown in the testimony of Dr. Norris, one of the 
surgeons of the hospital, who, in his notes to Lis- 
ton's Surgery, says he was enabled to treat with 
entire success a forward dislocation of the sternal 

Wallace's Statistics of Fracture : Med. Examiner, for 

1838. 

IS* 



210 MINOR SURGERY. 

end of the clavicle, after Dessault's bandage had 
been several times well applied, but without suc- 
cess. The difficulty of retaining the bone in its 
position here is so much more difficult than in 
cases of fracture, that it speaks highly for the 
powers of the apparatus. 

FRACTURES OF THE SCAPULA, 

Are generally accompanied by so much inflamma- 
tion from the contusion, as to render the removal of 
this an object of greater importance, than the treat- 
ment of the fracture itself. Warm fomentations, by 
means of bags of chamomile flowers, or flannels 
wrung out of hot water, leeches, &c, must therefore 
be first employed, after which we may employ 
the pad, and first and second roller of Dessault — 
Fox's Apparatus, or the bandage of Velpeau, 
which, as the author says, is applicable to acromio- 
clavicular luxations, to fractures of the acromion 
or other points of the scapula, to fractures of the 
neck of the humerus, as well as to fractures of the 
clavicle ; but from numerous opportunities of wit- 
nessing the result of its application to the latter 
injury in his own wards, it seems to be not as 
perfect in its cures as the means before spoken of. 
To the other cases it is exceedingly well adapted, 
and is applied as follows : — 

VELFEAU'S BANDAGE. 

Application. — Make the patient embrace the 
sound shoulder with the hand of the injured side, 
placing a compress or piece of muslin between the 
side of the chest and the injured arm, in order to 
prevent excoriation. Then place the initial extre- 
mity of a roller ten yards long, and two and a 






MINOR SURGERY. 



211 



half inches wide, under or behind the axilla of the 
sound side, and conduct it up over the back, over 
the injured clavicle, down on the front and outside 
of the arm, under the outside of the elbow, up 
and over the chest to the sound axilla. Make two 
turns like this, and on again reaching the axilla, 
pass circularly around 
the chest to the same 
axilla ; then make a 
turn over the clavicle 
and arm — then a cir- 
cular, and so on till it 
reaches the upper part 
of the forearm, as seen 
in the figure. By 
means of this bandage, 
especially when wet 
with starch or dex- 
trine, the arm is sup- 
ported in a firm cap, 
which will last for 
weeks without chang- 
ing; but where these 
articles are not used, several pins must be placed 
at the different turns in order to secure them. 




FRACTURE OF THE NECK OF THE HUMERUS. 

Bayer' 9 s Bandage. 

Composed of two rollers, two and a half inches 
wide ; — three strong pasteboard splints, between 
two and three inches broad, and the length of the 
arm; — a pad, four inches thick at one end, 



212 MINOR SURGERY. 

terminating at the other in a narrow point, and 
long enough to reach from the axilla to the elbow ; 
and thus serve as an inside splint, and fulcrum for 
the reduction of the fracture, the thick end being 
in the axilla, if the lower fragment is drawn in- 
wards, and the reverse, if the upper one is thus 
drawn. Lastly: a sling to support the forearm. 

Application. — The fracture being reduced, and 
maintained by the assistants, the surgeon fixes the 
initial extremity of one of the rollers, at the upper 
part of the wrist by two or three circulars, and 
winds it roundandupthearm as in the Spiral of the 
Upper Extremity ; taking care, however, when he 
arrives at the upper part of the limb, to make 
several turns around the fracture so as to bind it 
firmly ; from hence he carries the head of the rol- 
ler twice round the opposite axilla, and confides 
it to one of the assistants, who retains it upon the 
top of the shoulder of the injured side. The first 
splint being then placed in front, reaches from the 
bend of the arm as high as the acromion ; jthe se- 
cond, on the outside, from the external condyle to 
the same height ; and the third, from the olecranon 
behind to the margin of the axilla : these are given 
to another assistant to hold ; which he does by 
applying his hands near the bend of the arm and 
shoulder, in order not to obstruct the application 
of the bandage. 

The surgeon now takes the same roller, or a 
new one, and fixes these splints to the arm by 
moderately tight spiral turns, and pins the end on 
the shoulder, and while the assistants still keep up 
the extension, he places the cushion between the 
arm and trunk, taking care to put that end up- 



MINOR SURGERY. 213 

wards, which the deformity calls for : lastly, bring- 
ing the arm against the trunk, he confines it there, 
by means of the second roller, or turns of the same 
one applied in horizontal circulars around the body. 
The turns of the last roller should be rather tight 
below and slack above, if the fracture be displaced 
inward ; but if outward, they should be slack be- 
low and tight above, in order to act on the extre- 
mities of the lever, formed by the humerus. The 
forearm is to be sustained by a sling, which should 
not go under the elbow, as it might then cause 
shortening, but merely support the band. 

boyer's bandage for fracture of the body of 
the humerus. 

Composed of a single-headed roller, eight or nine 
yards long and two and a half inches wide ; — a 
compress of soft linen rag ; — four splints, not quite 
so long as the arm, nor so broad as to touch each 
other when applied ; and lastly, some lint or 
charpie. 

Application. — The surgeon, placing himself on 
the outer side of the limb, commences by passing 
a roller, carefully, round the hand and forearm to 
make a spiral of the limb, and prevent oedema of 
these parts ; fixing its initial end by a few circu- 
lars made above the wrist, and filling the hollow 
of the hand with cotton. His next care is to re- 
duce the fracture ; and being well assured that the 
arm has resumed its natural form and length, he 
continues the turns of the roller onward from the 
elbow to the upper part of the limb, applying the 
compress over the seat of the fracture, and filling 



214 MINOR SURGERY. 

up with cotton or some other soft material, the 
depression which corresponds to the insertion of 
the deltoid muscle, in order to effect a uniform 
pressure. That done, he confides the head of the 
roller to an assistant, and places the splints, well 
padded, along the arm, at the extremities of its 
transverse and antero-posterior diameters. Lastly, 
the assistant giving up the roller to the surgeon, 
and laying hold of the splints near the bend of the 
elbow, the latter proceeds to cover them in by 
spiral turns, and fastens the end of the bandage 
with a pin. 

Observations. — These constitute the usual 
dressings for the accidents mentioned. But if in 
fractures of the shaft of the bone the arm and fore- 
arm are not well secured to the body, or if the 
patient becomes restless, more or less motion will 
be produced at the elbow-joint, which must, of 
course, derange the lower fragment, whilst the 
slipping of the turfts of the spiral bandage on the 
forearm, will necessitate its almost daily reappli- 
cation. To obviate this, the use of an angular 
splint, such as will be hereafter described, well 
padded and extending from the axilla to the ends 
of the fingers on the inside of the arm, is usually 
resorted to in the Hospital, the three short splints 
above the elbow being also applied, as in Boyer's 
method. That is, the arm is first fastened to the 
angular splint by the ordinary spiral bandage, and 
then the short straight splints are applied, as be- 
fore seen. During the cure, the angle of the splint 
should be occasionally changed in order to prevent 
stiffness of the elbow-joint. It must be recollected, 
however, that this dressing is only applicable to 



MINOR SURGERY. 215 

fractures below the insertion of the deltoid ; when 
higher up, it will not answer. 

FRACTURE OF THE CONDYLE. 

PhysicWs Method. 

The position of the condyles to the elbow-joint, 
renders the treatment of a fracture of them a matter 
of great importance, as, without proper attention, 
the inflammation may extend to the joint, produce 
anchylosis, and deprive the patient of the use of 
the limb. When the fracture is simple, the best 
method of treating it is that proposed by the late 
Dr. Physick. 

The forearm being flexed on the arm so as to 
relax the flexor and extensor muscles, apply a 
bandage from the fingers up to the shoulder by 
spiral reversed turns, making a figure of S around 
the elbow. Then prepare two angular splints 
like the cut, and covering them well with cotton, 
apply one on the in- 
side, and the other on Fig. 154. 
the outside of the arm, 
from the shoulder down 

to the fingers, and con- 

fine them by another rT^- ■ „ "■ T'rrailllllllilHllHilll.liiiiiiHl 

spiral bandage applied 

exactly like the Spiral of the Upper Extremity. 
Then bring the forearm across the chest, and place 
it in a sling, the palm of the hand being next to 
the front of the chest, and the thumb pointing up- 
wards to the chin. In pursuing this treatment, 
attention must be paid to the state of the internal 
condyle, which, unless the splint is well padded, 
is very apt to ulcerate from the pressure. The 




216 MINOR SURGERY. 

angle, also, of the splint should be changed every 
third day during the treatment, after the first ten 
days, in order to prevent anything like anchylosis. 
If the fracture is complicated with contusion of the 
joint, or if it is compound, a better plan will be 
found in the use of a carved angular splint like 
the cut, in which the arm may lie, loosely con- 
fined by a few strips 
Fig. 155. of Scultet's bandage, 

||. while leeches, cold 

WJ UIm ^=r-~^^. applied to the part, to 

^^^fcj ' ' / JS| combat the inflamma- 

simply flexed and laid 
on a pillow till this is reduced, after which it is to ■ 
be treated as a simple fracture. In order to make 
this carved splint, or rather in order to make a 
carved splint for any of the limbs, pursue the fol- 
lowing plan. Lay the limb on a piece of stiff 
paper or soft wood, and mark an outline of its shape 
with a pencil, tracing accurately its angle, its pro- 
minences, &c, by run ning the pencil over its surface. 
Then seeing that the wood is thick enough to 
allow the limb to sink in it to the depth required, 
scoop it out in the lines of the pencil, and shave it 
off on the outside with a spoke-shaver or gouge, 
so as to reduce its thickness and make it corre- 
spond externally and internally with the round- 
ness of the limb. A piece of linen or muslin is 
then to be pasted over the outside to prevent its 
splitting from moisture, and the inside covered in 
the same way with soft buckskin to prevent the 
chafing of the skin. 

These splints are of great utility in the treat= 



MINOR SURGERY, 217 

merit of all injuries iu the neighbourhood of joints, 
and so simple that any one of the least mechani- 
cal ingenuity can make one that will answer the 
purpose very well, though the aid of a professed 
carver is desirable when a very light and perfect 
splint is required. 

FRACTURES OF THE FOREARM. 

Fracture of one or both bones of the forearm 
are dressed exactly in the same way, with the 
exception of fractures of the lower end of the 
radius, and of the olecranon or upper extremity 
of the ulna. The fracture being reduced by means 
of the extension at the wrist and counter-extension 
at the elbow, and the muscles well kneaded, in 
order to preserve the interosseus space, we can 
best dress it according to the plan of the hospital. 

This consists of two straight splints, long enough 
to extend from the bend of the arm beyond the 
fingers, half an inch wider than the forearm, and 
well padded with cotton, which is to be confined to 
them by a roller, and which should be thickest on 
their middle, so as to act as a pyramidal compress 
on the interosseous space. One of these splints 
should now be applied on the front, the other on 
the back of the forearm, whilst it is in a state be- 
tween supination and pronation ; or, in other words, 
while the bones are perfectly parallel, and confined 
there by a roller only moderately tight at first, so 
as to guard against swelling. After the lapse of 
a week, the roller may be drawn more firmly, so 
as to cause the padding of the splints to act on the 
interosseous space ; but we must be careful that 
it is not too tight. The case of amputation of the 
19 



218 



MINOR SURGERY. 



arm consequent on the mal-application of the rol- 
ler in a simple fracture of the radius, as before 
mentioned, should caution us against the use of 
too much traction in the application of the roller, 
especially at first. 



FRACTURE OF THE LOWER END OF THE RADIUS. 

Barton's Method. 

This fracture often similates a sub-dislocation of 
the wrist, owing to the falling of the hand, as seen 
in the cut, and so frequent is it, that eight out of 



Fig. 156. 




ten supposed sub-dislocations of the wrist will pro- 
bably be found to be fractures of this kind. For 
the best treatment of it, we are indebted to Dr. J. 
Rhea Barton. His apparatus is — 

Composed oitwo compresses, about three inches 
by two, or else two and a half inches square, and 
graduated from one end, — two splints prepared 
as in fracture of both bones of the forearm, and a 
two and a half inch roller. 

Application. — Place one of the compresses on 
the front of the wrist, with its thick end down- 
wards, and about one-eighth of an inch above the 
articulating end of the radius ; place the other on 
the back of the wrist, with its thick end upwards, 



MINOR SURGERY, 219 

so that it may be on a line with the upper row of 
the bones of the carpus, or on a line with the end 
of the first compress, so that one may begin where 
the other ends, though on opposite sides of the wrist. 
Fasten these by a few turns of a roller loosely 
applied, then place the two splints in their position, 
one on the front, the other on the back of the arm, 
extending from beyond the fingers up to the elbow, 
and bind them there by the spiral bandage, as in 
fracture of both bones. After a few days the 
tightness of the bandage may be increased ; and 
motion made to a slight extent in the joint to pre- 
vent anchylosis. If instead of the bulging on the 
back of the hand, as generally seen, it should be 
on its front, we have only to change the relative 
position .of the compresses, and then pursue the 
same plan, 

FRACTURE OF THE METACARPAL BONES, 

Is generally caused by heavy weights falling on 
them, and producing such a degree of contusion as to 
require our closest attention to combat the inflam- 
mation. In this case, we should employ a splint 
carved out to fit the arm and hand, placing a small 
mass of cotton under its palm, so as to preserve 
the convexity of the hand. Allow the limb to be 
thus open in the splint, till by leeches, cold washes, 
&c, we have reduced the inflammation. If, how- 
ever, the fracture is produced by a fall on the hand, 
we shall most frequently find it in the bone of the 
little finger, this being one extremity of the arch, 
and therefore most exposed to the shock. To 
dress this, place a mass of cotton in the hollow of 
the hand, as before done, and bandage the limb to 



220 MINOR SURGERY. 

a splint with a broad palmette or hand-piece. The 
splint should extend from the ends of the fingers 
up to near the elbow. 

FRACTURES OF THE PHALANGES. 

If simple, are first covered in with a spiral ban- 
dage of the finger, and then kept in their position by 
means of four small splints of binder's board; those 
on the front and back of the finger, reaching from its 
extremity as high as the wrist, and the two lateral 
ones extending only the length of the finger. 
These are to be padded with cotton, and confined 
by a second spiral of the fingers, the roller in each 
case being under an inch in its width. Attention 
should be especially given to the state of the joints 
in these fractures, a stiff finger being a serious in- 
convenience. 

FRACTURE OF THE OLECRANON. 

In this injury the upper fragment is drawn up 
by the action of the triceps. All the means of 
treatment have therefore the same object, viz., the 
bringing it down, or the placing of the two frag- 
ments as closely in contact as possible, in order to 
diminish the amount of ligamentous union. When 
from excoriation or other accidents one method is 
not available, another may be substituted, as all 
have some points which recommend them to par- 
ticular cases. 

SIR ASTLEY COOPER^ APPARATUS, 

Is Composed of two strips of muslin, each about 
half a yard long ; — two short rollers ; and another 
roller of the ordinary size ; — and a splint made 



MINOR SURGERY. 



221 



Fig, 157. 



of split wood, covered with cloth, 
and of a sufficient length to ex- 
tend from the margin of the axilla 
about half way down the fore- 
arm. 

Application. — The patient's 
arm being put into extension, and 
the upper fragment pressed down 
.until it touches the body of the 
ulna, a strip of linen is to be ap- 
plied above and below the joint, 
and one of the short rollers passed 
round the limb above, and the 
other below the olecranon, to se- 
cure them, as at b b. The extre- 
mities of each slip are then to be 
reflected and tied together, as at 
a, which draws the rollers nearer 
to each other, and places the frag- 
ments of the olecranon in the 
closest apposition possible. Last- 
ly, the split splint, c. well padded, is applied along 
the front of the arm, and secured by a bandage, 
d d, which is to be frequently wetted with an 
evaporating lotion. 

m. dessault's apparatus for the same, 

Is Composed of a strong pasteboard splint, long 
enough to cover a part of the arm and forearm, 
and shaped so as to accommodate itself to the bend 
of the elbow, when the arm is in a demiflexed 
position ; — a roller five or six yards long and two 
and a half inches wide; — and some compresses 
or lint. 

19* 




222 MINOR SURGERY. 

Application. — The limb being maintained by 
two assistants in demiflexion, the surgeon proceeds 
to cover in the hand and forearm with the roller ; as 
he approaches the elbow an assistant draws the 
skin, which is here usually wrinkled, gently up- 
ward, to prevent it from introducing itself between 
the fragments : the surgeon now pushes down the 
fractured extremity of the olecranon, in order to 
place it in exact contact with the ulna, and con- 
fines it in this situation, by means of a few turns 
of the roller, carried round the joint in form of a 
figure of 8, as in the bandage for phlebotomy : the 
elbow being at length covered, he carries the rol- 
ler spirally as far as the axilla, and applies the 
curved splint well padded with the lint or com- 
presses, along the front of the arm and forearm, 
fixing it by a succession of oblique turns of the 
remainder of the roller, carried down to the wrist. 

THE HOSPITAL APPARATUS, 

Is Composed of two,two and a half inch rollers,a 
splint to extend from the middle of the arm to below 
the middle of the forearm, and of the width of the 
arm, and some cotton or tow to fill up the hollow 
at the bend of the arm. 

Application. — Extend the forearm on the arm, 
and bring down the upper fragment, and whilst 
it is held by an assistant, apply the ordinary Spiral 
of the Upper Extremity from the fingers up to the 
shoulder, making figure of 8 turns around the 
elbow so as to keep the fragments in apposition, 
applying it firmly around the arm, to prevent the 
action of the triceps. Then apply the tow to the 
bend of the arm, and bind the padded splint on its 



MINOR SURGERY. 223 

front by a second spiral bandage. After ten or 
twelve days a slight degree of flexion should be 
made at the elbow and gradually increased to 
prevent stiffness. 

boyer's method. 

According to this distinguished surgeon the in- 
dications are to keep the fragments as closely as 
possible in apposition, without uselessly fatiguing 
the muscles by complete and constant extension 
of the forearm, and also, by rest, to favour the 
formation of the intermediate substance without 
allowing the ligaments of the joint to loose their 
natural flexibility. 

In order to do this, he flexes the forearm slightly 
on the arm so as to make an obtuse angle with it, 
and then applies an ordinary spiral bandage from 
the fingers to the elbow. The fragment being 
then drawn down, is confined by means of a nar- 
row strip or long compress which is placed behind 
it and fastened by crossing its ends in a figure of 
8 around the forearm. The bandage is now con- 
tinued over this compress so as to make several 
figures of 8, and then carried by spiral turns up to 
the shoulder so as to firmly compress the triceps. 
After the twentieth day he causes motion at the 
joint, and at the forty-fifth day the cure is com- 
plete, the union being then as solid as it ever will 
be. Should there be much swelling or pain, we 
should not apply the bandage or attempt the re- 
duction of the fracture, but allow the limb to lie 
loosely on a pillow, and combat, by topical ap- 
plications, the inflammation. If it does not dis- 
appear by the twentieth day, the case is to be left 



224 MINOR SURGERY. 

to nature, a number of instances having shown 
that even when thus left, it can preserve all its 
strength and freedom of movement. 



THE CARFO-OLECRANON HANDKERCHIEF OF M. MAYOR, 

Has been already mentioned. It will answer 
very well in many cases. 



THE UNITING BANDAGE OF GERDY, 



For transverse wounds, and for fractured patella, 
is also applicable here. When the fracture is com- 
pound, or complicated with severe contusion, it has 
been found useful in the hospital to place the limb 
in the carved angular splint before spoken of, and 
confine it by a few strips of Scultet's bandage, 
employing leeches, cold washes, &c, as in corn- 
pound fractures of the condyles of the humerus. 



FRACTURE OF THE CORONOID PROCESS OF THE ULNA, 

Resembles a dislocation of the bones of the fore- 
arm backwards. By pulling the forearm, and 
at the same time flexing it, the dislocation is re- 
duced, but will return immediately when this 
force is removed. In order to prevent this, flex 
the forearm and bind a padded angular splint 
along its inside, so as to keep it flexed for several 
weeks ; the action of the brachialis internus being 
prevented by the turns at the elbow. This acci- 
dent is a very rare one, Dr. Physick having seen 
but one case which he thus treated. 



MINOR SURGERY. 225 

FRACTURES OF THE LOWER EXTREMITY. 

In no case requiring surgical attention, has 
there been as many proposed plans of treatment 
as in the fractures of which we are now speaking. 
Almost every year, and from almost every section 
of the country, have we accounts of some new mo- 
dification, or some decided improvement in their 
apparatus, which, in the opinion of the inventor, 
and from the decided testimony of one or two per- 
fectly cured cases, must supplant everything here- 
tofore known, when, perhaps, the great and im- 
proved modification consists only in the substitu- 
tion of narrow strips for broad bands, or in the 
difference of a buckle, or the peculiar shape of a 
hinge. To refer, then, to these, would be as use- 
less as uninteresting ; and we shall, therefore, pre- 
sent only the more original plans, premising a few 
remarks on the duties of the surgeon in the pre- 
paration of the means requisite for their treatment. 

When called to a fracture, or even a supposed 
fracture of the lower extremity, our first duty 
should be to consider in what way the patient 
may be most readily moved, and prepared for his 
dressing, and then how that dressing itself is to be 
obtained. 

First. How are we to prepare for the removal 
and dressing of the patient. 

In cases of this kind, we most frequently find 
the patient laying on a couch or settee, and en- 
cumbered with his ordinary dress, and we know 
that for the proper treatment of his case, perfect 
rest is almost absolutely essential. Our thoughts, 
therefore, naturally turn to his place of rest during 



226 MINOR SURGERY. 

the treatment. An ordinary bedstead, provided 
it is low, narrow, with a low head-board, and 
without a foot-board, may readily be adapted to 
our wishes, or made into what is called a Fracture 
JBed, by first drawing the sacking-bottom as tightly 
and drum-like as possible ; or if slats can be had, 
by placing them in their position. Cut, then, in 
the centre of either, a hole large enough to admit 
a pot, and nail on the underside of the bedstead, 
at a distance to correspond with the width of the 
pot, two strips grooved or ploughed like the strips 
in which an ordinary counter-draw runs, so that 
they may receive the rim of the pot, and allow of 
its sliding in and out under the patient. If a num- 
ber of these bedsteads are required, as in a hospital, 
it will be found most useful and cleanly to have 
them made of iron, as they are then more readily 
preserved from bugs, fee- 
After the bedstead, we should prepare a hair 
or firm and even mattrass to fit the bedstead, by 
cutting out a piece to correspond with the hole in 
the frame, and sew the cut edges of its ticking 
together, after having well arranged the stuffing, 
so that the edges of the hole may not be hard or 
knotted. We then place over this a sheet with a 
similar hole in its centre, and arrange on it the 
preliminary portions of the apparatus to be used, 
after which we may turn our attention to the pa- 
tient. Having carefully removed his clothes, &c, 
we should prepare to remove him to the bed. To 
do this properly, see that the open side of the set- 
tee corresponds with the side of the bed, and the 
head of the patient with its head, especially if his 
roomisnarrow; otherwise we shall be compelled to 



MINOR SURGERY. 227 

carry the settee out of it, and perhaps down stairs, 
in order to turn it, as we have occasionally seen 
done, and thus give unnecessary pain and trouble. 
We next procure three assistants, and having in- 
formed themof their duties, place one at each shoul- 
der of the patient, so as to face each other, and the 
third at the pelvis on the sound side, while the sur- 
geon himself takes charge of the injured limb, and 
directs the assistants at the shoulders to pass one 
of their arms under the patient's neck and shoul- 
ders. Let them now slide their other hands under 
his buttock, so as to clasp each other's fingers in 
what is known as the sailor's grip, or, in other 
words, grasp hands, by making the palmar side of 
their fingers touch. 

The third assistant, holding the sound limb, the 
surgeon places one hand under the seat of frac- 
ture, the other under the calf, if in the femur, and, 
at the word, directs the assistants to lift and carry 
the patient down to the foot of the settee, so as to 
get free from it, and then, passing one on each 
side of the narrow bedstead, to place their burthen 
so that the lower part of the buttocks may corre- 
spond with the upper edge of the hole in the mat- 
tress, when the dressings may be readily applied. 
If, instead of a fractured thigh, it is a fractured 
leg, the arrangements should be the same, except 
that the surgeon should grasp the leg with both 
hands, one being at the kne^e, and the other just 
below the seat of fracture, or at the ankle. 

These directions, though minute, are absolutely 
necessary to prevent the suffering of the patient, 
and the awkwardness produced by a want of at- 
tention to them, as assistants or inconsiderate 
surgeons are very apt so to place themselves, that 



228 



MINOR SURGERY. 



on moving, they come directly between the bed 
and the patient, which necessitates their lying 
down or crawling across the bed in order to get 
out of the way. 

But where it is difficult to pre- 
Fig. 158. pare the bed as thus directed, a 
very excellent and simple substi- 
tute will be found in a frame made 
of sacking or strong cloth, nailed 
on two narrow strips the length of 
the bed, and joined by two trans- 



verse ones, as in the figure. This 



is to be placed on an ordinary firm 
mattress, and a sheet, with a simi- 
lar hole being placed over it, the 
patient will lie as on an ordinary 
bed till he requires a stool, when 
assistants at the head and foot of 
the bed, may raise the frame like 
an ordinary "hand-barrow, and by 
placing its ends on four heavy 
chairs, readily air the bed, or even 
remove it, and of course can also 
easily pass a pan under the frame 
to receive the discharges. 

Having now completed these 
arrangements, we should proceed to the 

Preparation and application of the apparatus. 
This will, of course, depend on the injury. In 
fracture of the femur below the neck, the extended 
position, as recommended by the French surgeons, 
is almost the only one employed here, and the ap- 
paratus of Dessault, as modified by Drs. Physick 
and Hutchinson ; the apparatus of Boyer, modified 




MINOR SURGERY. %29 

by Hartshorne, or that of Hagerdon modified by- 
Prof. Gibson, are almost the only ones employed, 
though we occasionally see the plan of Amesbury, 
and of Prof. Nathan R. Smith, in use, in special 
cases. In fractures of the neck of the femur, es- 
pecially in old persons, it is generally sufficient to 
lay the limb bent on itself, on a double-inclined 

Fig. 159. 




plane, as that of Sir Charles Bell, or we may use 
the method of Dupuy tren, in which a double-inclined 
plane is formed by cushions of different sizes cover- 
ed by a common sheet. 

dupuytren's plane. 

Application. — Three or four cushions, decreas- 
ing in size from below upward, are placed under 
the ham ; the rest of the cushions are so disposed 
as to form a double-inclined plane. The thigh is 
made to repose upon that plane which corresponds 
to it, while the leg in a state of flexion rests upon 
the other ; and the limb is maintained in this position 
20 



230 MINOR STJRGEirf. 

by means of a sheet folded like a cravat, the 
central part of which should embrace the foot? 
while the extremities are attached to the sides of 
the bed. 

Simple, however, as this is, the plan usually pur- 
sued with us is more so, and answers equally as well. 
This consists in doubling an ordinary pillow on 
itself, and placing it under the ham and leg, thus 
making a plane of the simplest kind, and giving, 
by the addition of a band to fix the foot, all that 
is requisite for the treatment of this injury. 

But in fractures of the shaft of the bone, the ex- 
tended position being preferable to the bent one, 
the treatment is very different. Here, owing to the 
shortening produced by the muscles, we must em- 
ploy some means of making extension and counter- 
extension, as it is usually termed ; though not so 
in reality, as the means of extension should always 
be the hands of the surgeon, and the bands be 
used only to preserve the extension when he has 
made it. 

To do this, various bands have been employed, 
but it matters little of what they are made, pro- 
vided they are flexible, soft, and porous, espe- 
cially the latter, so as not to unduly promote the in- 
sensible perspiration, and thus favour excoriation. 
But as these qualities are seldom found united, 
most of the means of preserving extension are 
made of two substances, the best of which* are 
brown holland linen, and buckskin. These may 
be employed either as in the gaiter of Dr. Physick, 
or the band of Dr. Coates. 

DR. COATES'S BAND FOR FRESERVING EXTENSION. 

This is made of a piece of brown holland, 



MINOR SURGERY. 231 

slightly biassed, but leaving the central threads 
continuous throughout, from fifteen to eighteen 
inches long, if designed for an adult, two inches 
wide in the middle and narrowing on each side, 
2'apidly at first, then slowly, towards the extremi- 
ties, which are an inch in width. This is to be lined 
throughout nearly its whole length with thick 
buckskin, a very little wider than the linen, the 
latter being simply basted to the former by stitches 
which dip but half way through the skin, in order 
that they may not produce irritation. Two pieces 
of tape, each an inch wide, are sewed securely to 
the ends of this band, so as to make it long enough 
to go over the lower end of the splint. In apply- 
ing. 160. 




ing this, place the centre of it over the tendo- 
Achilles, and bring the ends round above the 
malleoli to the front of the ankle, cross them on 
the top of the instep, and carrying them down, knot 
them beneath the instep a short distance from the 
sole of the foot, when the tapes are to be carried 
over the end of the splint, and tied. 

Where this band cannot be readily obtained, a 
common handkerchief folded into a similar shape 
and applied like this band, answers quite as well. 
But in some cases, owing to the irritability of the 
patient, and the extension being made by the band 
instead of the hands of the surgeon, or owing to a 



232 MINOR SURGERY. 

want of attention to the smoothness of the band, 
excoriations will happen. It is desirable, there- 
fore, to be able, by changing the means of preserv- 
ing extension, to bring the pressure to bear on 
different points, and we may resort to the fol- 
lowing : 

physick's gaiter. 

Composition. — This is made of buckskin and 
kid, of cloth and buckskin, or hollands and buck- 
skin, but in either case the buckskin should go 
next to the skin, as it is the softest, most porous, 
and flexible of all these substances. 
Fig. 161. Cut out of either of these substances 
two pieces of the shape of the figure, 
and make it eleven or twelve inches 
long at its greatest length, and eight 
inches at its least for an adult, and 
about four inches in its other diame- 
ter. Work eyelet holes in the ends 
to receive the cord which laces it to 
the ankle, and sew a piece of buck- 
skin on the inside of one end, so that it may come 
under the lacing when the gaiter is applied, and 
prevent the cord from pressing on the skin : lastly, 
sew on two broad tapes or bands of about three- 
fourths of a yard long in order to pass to the end 
of the splint. 

In applying this, place a layer of carded cotton 
on the surface which is to be next the skin, and lace 
the gaiter smoothly round the ankle from an inch 
above the malleoli down on to the front of the 
instep. Should the use of this cause pain, we 
should at once look to it, and if a slight change in 
its arrangement does not relieve it, or should it 




MINOR SURGERY. 233 

produce excoriation, use some other band, as the 
handkerchief of Dr. Barton, as before treated of, 
under the handkerchief system. 

With these means of preserving extension, we 
shall have ail that is necessary. Let us now look 
to the means of counteracting them, or the means 
of counter-extension. The padded band of Des- 
sault or Boyer, the bandage doubled several times 
on its length, or the use of a thick cravat, may all 
be objected to, as frequently causing excoriation 
of the part ; we shall, therefore, confine ourselves 
to the consideration of Coates's Perineal Band, 
which is decidedly the most perfect means that 
we have. 

COATES'S PERINEAL BANDp 

This is made of a piece of brown holland, long 
enough to go round the perineum in the line of 
the groin, and reach above the crista ilii both be- 
fore and behind. For an adult it should be three 
inches wide. Double it in .its width, and sew 
the edges firmly together, leaving one end open 
and closing the other, and turn it inside out like a 
bag. Then pour in bran or chaff sufficient to fill 
it lightly, and quilt one-third of the closed extre- 
mity so as to flatten it to the thickness of half an 
inch, Pour in a little more bran, and stuff it firmly 
till the central third is quite round and firm ; and 
closing the open end, quilt the terminal one as be- 
fore, attaching to each end two broad tapes of three- 
fourths of a yard long. Next take a piece of soft 
buckskin about three inches and a half wide and 
about half as long as the band, double it, and stitch 
the edges together so as to form a tube with the 
20* 



234 MINOR SURGERY. 

ends open, so that when the band is applied, it 
may be slipped over and cover that part of it 
which is to press on the pubis, perineum, and 
tuberosity of the ischium; and the seam being 
turned from these parts, secure it firmly to the 
band by a few stitches. When soiled, this may of 
course be easily changed. The buckskin is a great 
improvement to the ordinary band ; and, accord- 
ing to the experience of the inventor, and from 
what we have ourselves seen, seldom or ever pro- 
duces irritation. 

Fig. 162. 




In connection with these bands, and before 
describing what remains of the apparatus for 
fractures of the femur, let us glance at the 
remarks of Dr. Coates in relation to the delay 
attending our preparations. " There is scarcely 
ever," says he, " a necessity for rapid action in a 
case of fractured leg or thigh, but it would be 
wrong to leave the patient to undergo the gradual 
shortening of the limb from continual muscular 
action, while the surgeon rides off for his splints, 
or while he superintends their preparation in the 
shop of some carpenter who never saw what he is re- 
quired to make. Let him, therefore, secure the limb 
by temporary means, and save his patient the ex- 
quisite pain of involuntary motions, the irritation 
from the pressure of the fragments upon lacerated 



MINOR SURGERY. 



235 



Fig. 163. 



muscles, and the increased force required to over- 
come their contraction. Let 
the patient, therefore, be placed 
on the bed diagonally, and 
with extending and counter- 
extending bands made of tow- 
els, handkerchiefs, &c, employ- 
one head-post and the opposite 
foot-post for securing him. 
The surgeon can then proceed 
coolly and leisurely for his ap- 
paratus, certain that his patient 
suffers but little, and that scarce 
anything is lost by delay." 

We now proceed to the 
Junct-Bags, or the stuffed bags 
intended to prevent the pres- 
sure of the splints against the 
sides of the limb. These are 
made of muslin of the length 
of the limb, or rather, long 
enough to extend on its out- 
side from the pelvis to the ex- 
ternal malleolus, and on its 
inside, from the perineum to a 
point a little above the in- 
ternal one. One end of this 
being sewed up, it is to be 
filled with bran or chaff till 
moderately full, and then the 
open end being closed, it will form a cushion of 
the width of the splint, and like the figure. 

THE SPLINT CLOTH, 

Is a piece of muslin, a yard and a half long, one 
yard wide, and intended to keep the splints to- 






i 



236 



MINOR SURGERY. 



gether, and form a kind of box, by being wrapt 
around them. 

THE BANDAGE OF SCULTETUS, 

Which is also sometimes necessary, is made 01 
strips of muslin about three inches wide, and of a 
length gradually decreasing from the first strip. 
Fig. 164. 




This should be long enough to go once and a 
third round the upper part of the limb, and each 
subsequent strip should be one-half inch shorter. 
To prepare and apply them, lay down the longest 
strip on a pillow or board, so that the whole may 
readily be placed under the limb without being 
deranged, and place each strip so that it shall 
cover only one-third of the preceding one. Then 
placing the limb on these {obliquely in regard to 
their length, in order to favour their application), 
commence at the lowest part of the limb, and gra- 
dually ascend, drawing each strip moderately 
tight. When it is necessary to change one or more 
of the strips, undo the bandage, and attaching the 



MINOR SURGERY. 



237 



fresh hand to the soiled one, draw the latter out, 
and thus place the fresh one in its place without 
deranging the limb. 

THE EIGHTEEN-TAILED BANDAGE, 

Is Composed of a strip, three inches wide and 
as long as the limb, to which are stitched cross- 
wise, eighteen or more strips of an equal width, 
and sufficiently long to make a turn and a half 
about the limb, and cover in each other by about 
two-thirds, each having a slight degree of obliquity 
relative to the longitudinal piece. It was formerly 
applied like the bandage of Scultetus, but has 
been supplanted by it, as its strips could not be 
changed, owing to their peculiar construction. 

The Splints for fractured femur differ in their 
form. Those of Dessault consist of one for the 
outside of the limb, long enough to reach froixi the 
spine of the ilium to four inches beyond the foot, 

Fig. 165. 




and of another extending from the perineum to 
the sole of the foot, both of them of the width of 
the limb. In the upper part of the outside one 
are holes to receive the counter-extending band, 
and atitslowerend one for the extending band. To 
these were added a third splint,junctbags,Scultet's 
bandage, &c, as shown in the cut. (Fig. 165.) 



238 MINOR SURGERY, 



DR. PHYSICK S SPLINTS, 

Are like these, except in the addition to the 
length of the outer one, by which the end went 
nearer the axilla, thus making the counter-ex- 
tension more in the line of the body, and 
preventing any inclination to that side, whilst 
the addition of a block by Dr. Hutchinson, 
made the direction of the extending band also 
more in the line of the limb. To these were added 
some means of extension, counter-extension, 
Scultet's bandage, &c, as before spoken of. With 
slight modifications, this is the apparatus now 
employed in the Pennsylvania Hospital, and, as 
the experience of the large number of cases there 
treated, proves it to be all that is requisite for 
simple fracture of the shaft of the bone, it is 
strongly recommended as the most simple of our 
means of treatment. 

•Application. — Having arranged the patient, 
the bed, and the apparatus, as before shown, we 
place the patient on the fracture-bed, with his 
buttocks corresponding to the hole, and the 
counter-extending band of Coates, in its place. 
We then roll the splints in the splint-cloth 
on the floor, so that the splints may be of the 
proper distance apart, and give them to an assist- 
ant. The means of. preserving extension being 
placed on the foot, we seize the limb above the 
ankle with both hands, and draw it gradually 
and steadily down till it is nearly the length of 
the sound limb, or till the spasmodic contraction 
of the muscles is overcome. This may require 
five or twenty-five minutes, when the splints 
and splint-cloth may be slid under and up the 



MINOR SURGERY. 



239 



sides of the limb by the assistant. The splints now 
lying on the bed, the junct-bags are placed on 
them, and their stuffing made to correspond with 
the prominences and depressions of the limb, when 
the outer splint may be pressed to its side, the 
junct-bag being in position, and the counter-ex- 
tending tapes tied on its outside through the 
holes at the upper part. Then the extending tapes 
being pass p } over the block, and one of them 
through the hole at its lower end, both are to be tied 
on the extremity of the splint so as to secure the 
extension gained by the hands of the surgeon, 
who keeps up this extension till the bands are 
fixed, and the outer splint in its place. The junct- 
bag being then arranged on the inner splint, 
and it, turned against the side of the limb, three 
Fig. 166. 




pieces of roller are passed under the hollow of the 
knee and slid up and down the limb to their posi- 
tion, and tied on the side of the splints. Looking 
now to see that the patient's body is perfectly 
straight in regard to his limbs, which may be told 
by seeing that the two anterior superior spinous 
processes are on the same level, measure from them 
to the internal malleolus of each limb, to see 
what is the difference in their lengths. Then 
placing a hoop, bent as in the figure, over the toes 



240 MINOR SURGERY. 

to keep off the weight of the bed-clothes, the dress- 
ing is completed. If, after two or three days, or 
even ten days, we find there is still shortening of 
the limb, make the extension with the hands as 
before, and daily drawing on the limb thus, pull 
it down and tighten the bands, till it is of the same 
length, or as much so as possible, a difference of 
an eighth of an inch not being perceptible in the 
gait. Generally the reduction is completed at the 
second visit, but we caution the young surgeon 
against believing that the fractured femur will in 
all cases, or even in the majority of them, be 
perfectly of the length of the sound one. In 
favourable cases the difference will scarcely be 
perceptible ; but if attention is not paid to the posi- 
tion of the spinous processes, we may readily de- 
ceive ourselves, and prove the limb as long, or even 
forager, than the sound one, a point of which some 
have boasted when speaking of the success of their 
treatment. If excoriation of the heel is likely to 
occur, the placing of a piece of kid spread with 
soap cerate on the part affected, or the substitution 
of some other means of preserving our extension 
so as to vary the point of pressure of the band, 
should be resorted to. In this method, it is 
seen that the bandage of Scultetus, or other ban- 
dages, or short splints on the front or back of the 
thigh, are dispensed with, no advantage being de- 
rived from their use in the majority of cases, whilst 
we can, owing to their absence, examine the state 
of the fracture, apply cold washes to combat any 
inflammatory action, and yet not derange the limb 
by their application. 



MINOR SURGERY. 241 



BARON BOYER S APPARATUS, 

Is Composed of a splint, of particular construc- 
tion for extending the limb ; — a foot-board ; — a 
padded belt or perineal band, which is buckled 
round the upper part of the thigh ; — two common 
flat splints of the length of the limb, one for the 
anterior and the other for the internal part of the 
thigh; — and some junct-bags, tapes, and wadding. 

The outside splint is about four feet long and 
three inches wide. Along half its length runs a 
groove, about half an inch broad, the extremity 
of which is covered with iron ; to this groove a 
screw is adapted, which occupies its whole length, 
one end of it being supported against the plate of 
iron covering the extremity of the groove, and 
the other made to fit a handle by means of which 
it is to be turned. On the inside of this splint a 
contrivance for holding up the foot-piece is fast- 
ened to the screw. The upper part of the splint 
is received in a sort of pouch or bag adapted to 
the external side of the perineal or thigh belt. 
The sole piece, or foot-board, which has two 
branches at its inferior part, is made of iron, and 
covered with soft leather. This is connected by 
means of a mechanical contrivance, as just men- 
tioned, with the screw. To that part of the sole 
which is near the heel, is attached a broad piece 
of soft leather, which being split on each side into 
two straps, serves for fixing the sole to the foot. 

The perineal band is of strong leather, covered 
with buckskin, and well stuffed with wool : near 
the place where its two ends are buckled together 
21 



242 



MINOR SURGERY. 



on the limb, a little leather pocket is sewed for 
receiving the upper end of the external splint. 

Application. — The patient being properly dis- 
posed upon the bed, a piece of linen, of the length 
of the limb and about three-quarters of a yard 
broad, CdLlledporte-attelle, or splint-cloth, is passed 
under the limb, lying upon five tapes. In the 
next place, the perineal band is applied, the sur- 
geon having previously surrounded the upper 
part of the limb obliquely with a cushion of wad- 
ding, four fingers' breadth wide, and the length 
of the thigh-belt, or with the junct-bag, in order 
to moderate the pressure of the latter, and render 
it more supportable. The hollows of the sole of 
the foot and lower part of the leg are filled up 
with wadding or tow, and the foot-piece, is fast- 
ing. 167. 




ened to the former by means of the soft leather 
straps attached to its under surface, which pass 
round the lower part of the leg : should, however, 
these straps appear insufficient to fix the iron sole 
to the foot firmly, an extra band may be applied 
in the same manner, of calico or linen. 

That done, the surgeon proceeds to the reduc- 
tion of the fracture, and afterwards adapting the 
upper extremity of the splint to the pouoh of the 



MINOR SURGERY. 243 

perineal band, the foot-support being connected 
with the splint, the cushions, and the anterior and 
internal splints are to be applied, and the whole 
fixed by means of the tapes, as in the ordinary 
apparatus for fractures of the thigh. Lastly, by 
turning the winch, the iron sole is lowered, draw- 
ing the foot, to which it is attached, along with 
it ; and the superior extremity of the splint is 
pushed upward, and the member elongated to the 
necessary extent. 

DR. HARTSHORNE'S SPLINTS. 

These are generally spoken of as modifications 
of Boyer's, but differ so much from them as to be 
almost entirely new. They are 

Composed of an outer splint, long enough to 
reach from four inches below the heel nearly to 
the axilla, and of an inner splint which goes from 
the same point, up to the perineum. In the lower 
extremity of each of these is a long mortise, in 
which the foot-board slides, or is moved by the 
screw. The upper end of the inner splint is 
covered with a pad of horse-hair, which is again 

Fig. 168. 

~~Jj':L 



w 



— ■ ■■':■.-£; "jlS 



covered by buckskin. An ordinary gaiter and a 
handkerchief complete it. 

Application. — Fix the gaiter or band on the 
foot, and pass the splints on each side of the limb 



244 



MINOR SURGERY. 



till the inner or padded one touches the perineum. 
Then attach the t&pes of the gaiter to the upper 
block or foot-board, and by turning the screw draw 
it down, and the limb will follow this movement 
till the perineum bears on the pad, when it is 
stopped, and the counter-extension made by means 
of the padded end of the inner splint. 

Junct-bags may be placed between the splints 
and the limb if they press too much against it, but 
generally this is not the case, and in cases of com- 
pound fracture where they would be soiled by the 
discharges, it is an advantage to omit them. It is 
chiefly in cases of this kind that we can use these 
splints to the greatest advantage. The extension 
and counter-extension being kept up chiefly by 
the inner side, we can remove the outer splint 
and dress the wound without taking the extension 
from the limb. Care must, however, be observed 
in the use of this splint, that the pressure upon 
the integuments of the perineum does not produce 
a slough. 

amesbury's apparatus for fractures of the femur. 

Composition. — This apparatus is divided into 
three portions, independent of splints and straps; 

Fig. 169. 




MINOR SURGERY. 245 

one is for the thigh, Fig. 169, a ; another for the 
leg, b ; and the third for the foot, c. There are two 
thigh-pieces made to each apparatus, one of which 
is bevelled off at the lower end to the right and 
the other to the left, so that when one of them is 
fixed to the leg-piece, which is hollowed out to 
receive the back of the leg, the leg and thigh- 
piece together are adapted to the natural line of 
the right limb ; and when the other thigh-piece 
is joined to the leg-piece, they are adapted to the 
natural line of the left limb : this arrangement 
Mr. Amesbury considers necessary, in order to 
preserve the figure of a perfectly formed limb, 
which is not straight, but turns inward a little at 
the knee. The leg and thigh portions are con- 
nected by means of a little steel or brass pin, d. 
Behind the apparatus is a steel bar, e, coated with 
brass, and fixed to the back of the leg-piece. To 
the upper end of this bar is fixed what Mr. Ames- 
bury calls a brass foot, Fig. 170,^ to which is 

Fig. 170. 




attached a bolt acted upon by a spring. There 
is a hole in the centre of this brass foot, which is 
traversed by the bolt in the transverse direction. 
At the back of each thigh-piece is a rack, g> with 
several projections, each having a hole bored 
through the middle, for the purpose of receiving 
the bolt attached to the brass foot-piece. The 
21* 



246 ^flNOR SURGERY. 

foot-piece is connected with the steel bar in such 
a mariner as to be easily fixed upon either of these 
projections. By being fixed upon either of these, 
except that nearest the leg-piece, the leg and thigh- 
pieces become fixed together so as to form a dou- 
ble-inclined plane (see Fig. 169); the angle of 
which may be varied at pleasure by altering the 
position of the brass foot-piece from one of the 
teeth or projections of the rack to another. At 
the upper end of the thigh-piece is a sliding brass 
plate, A, Fig. 170, so adapted that it may be ap- 
plied to either of the thigh-pieces at pleasure. 
This contrivance allows of the thigh part of the 
apparatus being adapted to thighs of various 
lengths. The upper end of this plate is turned 
off, so that, when it is properly padded, it may 
bear against the tuberosity of the ischium without 
injuring the integuments. At the back of the 
sliding plate are placed a couple of brass bars, i i, 
which answer the double purpose of rendering 
the sliding plate more secure when it is fixed upon 
the thigh-piece, and of preventing the pelvis-strap, 
to be noticed presently, from slipping from the 
apparatus. There are little studs, /, placed at the 
back of the apparatus, for the purpose of receiving 
the straps by which the apparatus is confined to 
the limb. 

The pelvis-strap is of leather, furnished with 
a sliding pad, and is long enough to reach round 
the thigh and round the pelvis. 

Three short splints are also required, to be 
placed upon the thigh. 

Application. — The apparatus and splints being 
properly padded, the surgeon commences by plac- 
ing the pelvis-strap between the bars and the plate 



MINOR SURGERY. 



247 



or sliding portion ; he then applies a single-headed 
roller, d, Fig. 171, spirally about the leg from the 
toes to the bend of the knee. In the next place, 

Fig. 171. 




an assistant takes the small of the leg in one hand, 
and places the other under the knee to raise the 
limb, and at the same time to keep the knee bent 
while the surgeon places the apparatus under it. 
When the limb is properly placed, the shoe, a, 
previously padded in the inside, is buckled to the 
foot, while the foot-board, b, and leg-piece, are 
placed at nearly right angles : this gives the foot 
support, and steadies it. The leg is to be sup- 
ported along the whole of its under surface in 
order to give it an equal bearing upon every point 
of the apparatus, and this is done by means of 
tow or wadding, c, placed under the small of the 
leg, between the long pad and the leg-piece. The 
leg is fixed upon the apparatus by a roller carried 
spirally round both from the ankle to the bend of 
the knee. To confine the fractured parts in their 
natural position, the assistant takes the apparatus 
and the knee between his hands, and extends the 
thigh gradually in a line with the thigh part of the 



248 MINbR SURGERY. 

apparatus, which the surgeon supports against the 
back of the thigh. When the surgeon has co- 
aptated the fragments of the bone, he applies the 
splints ; the first, e, on the outer side of the thigh, 
from the great trochanter to the lower part of the 
outer condyle ; the second on its inner side, reach- 
ing from the pubes to the lower part of the inner 
condyle ; and the third,/, upon the fore-part of the 
thigh, from a little below the superior anterior 
spinous process of the ilium, to the base of the 
patella. The splints are kept in place by the straps, 
g g g, fixed to the studs on the back part of the 
apparatus. Lastly, the pelvis-strap, A, is to be 
carried round the limb, under the strips of leather 
of the splints, and made to cross on the outer side, 
while the buckle-end, with the sliding pad, is car- 
ried round the pelvis and made to meet the other 
end in front, where it should be buckled. The 
tapes, i i, serve for fixing the lower part of the ap- 
paratus to the foot of the bed. 

gibson's modification of hagerdon. 

Composition. — Two splints half an inch thick, 
formed at the upper extremity like the head of a 
crutch, five inches wide just below this head, five 
feet and a half long for an adult, and tapering to- 
wards the lower end which is about two inches 
wide. These lower ends for the extent of a foot 
are straight, and have six or eight holes at equal 
distances, large enough to receive a stout peg in- 
tended to secure the foot-board. Shoulders are 
made in the splint just above the last peg-hole, to 
prevent the foot-board from ascending. The foot- 
board itself is made of seasoned, tough wood, an 
inch thick, twelve inches long, and nine wide. In 



MINOR SURGERY. 



249 



this are three rows of slits half an inch wide, and 
an inch and a half long, intended for the straps of 
the gaiters which are to secure the feet to the 
board. Two other slits receive the ends of the 
splints, thus making eleven perforations in the 
foot-board. The gaiters are like Physick's gaiter, 
with two additional straps, so that there are two 
near the instep and two near the heel, long enough 
to pass through the foot-board, and tie on its back. 
Application. — The bed being prepared, as be- 
fore mentioned, and the patient placed straightly 
on it, the gaiters are applied to both feet, and the 
fracture set. The splints with junct-bags, or else 
the splints themselves padded, are then applied 
and the foot-board fastened to them ; when the 
feet, protected by two small cushions beneath 
them, are to be secured to the board by passing 
the straps through the holes and tying them on 
the outside, and the splints are to be secured to the 
body by four or five pieces of rollers. 

Fig. 172. 




In this apparatus both limbs are confined, and 
the counter extension is made at the acetabulum 
of the sound side by means of the sound limb. 
Consequently, we must guard against any bending 
of the sound knee, as that would at once do away 



250 



MINOR SURGERY. 



with the use of the sound limb as a splint, and 
permit shortening. 

A very simple apparatus for the treatment of 
certain cases of this fracture, is to be found in the 
following plan. 

gibson's simple-inclined plane. 

Composition. — A board sixteen inches wide, 
two feet four inches high, and with six mortises 
near its upper extremity, is placed vertically ; 
another board of similar breadth and length is 
placed horizontally ; a third, three feet long, and 
extending from the extremity of the horizontal 
one to within ten inches of the top of the upright 
one, forms an inclined plane, and the whole joined 
together forms a triangle. 

Fig. 173. 




At the lower end of the inclined board is an open- 
ing six inches wide and eight long, to allow of the 
passage of faeces and urine to a vessel below. 
Thereare likewise two mattresses, two footcushions, 
and a pair of gaiters. The larger mattress of the 



MINOR SURGERY. 



251 



length and breadth of the inclined board is two 
and a half inches thick, and fastened to the board 
by straps on its edges. The smaller mattress fills 
up the opening for the passage of faeces, &c. The 
gaiters and foot cushions are as before described ; 
and lastly, there are two round pins, each six 
inches long, which are passed through holes in the 
inclined plane. 

Application. — Place the patient on this, as seen 
in Fig. 173, the fastening of the feet makes the 
extension, and the weight of the body the counter- 
extension, and thus places the limbs in an easy 
position, and one very favourable to the reduction 
of any inflammation. Where, from peculiar cir- 
cumstances, we wish to allow a certain degree of 
motion to the limb, we may find it useful to employ 



PROF. N. R. SMITH S APPARATUS. 

Composition. — This consists of four pieces, 
viz. : — two concave-inclined planes, one of which 
is adapted to the inferior surface of the thigh, the 



Fig. 174. 




252 



MINOR SURGERY. 



other to that of the leg, and united by a hinge 
corresponding to the knee. The third piece is for 
the foot, and the fourth connected with the thigh- 
piece extends up the side of the body. (Fig. 174.) 
The limb is placed in it, as in Fig. 175, and is then 
suspended. It is, however, a some what complicated 
apparatus, or at least one that is not readily made 



Fig. 175. 




at the moment, but makes when applied a very 
light and excellent double-inclined plane. The 
figures give a good idea of it, and those who may 
wish to construct one, will find a minute account 
of it in all its parts, by Prof. Smith, in Geddings's 
Baltimore Med. and Surg. Journal, vol. L, 1833. 

FRACTURE OF THE PATELLA. 

In this fracture the upper fragment is drawn up 
by the action of the quadriceps femoris, conse- 
quently the indications in the treatment are to 
overcome this, and bring the fragments as closely 



MINOR SURGERY. 253 

in apposition as possible, in order to shorten the 
ligamentous union, and thus preserve a more per- 
fect use of the limb. To do this, various means 
have been proposed by Dessault, Amesbury, 
Cooper, Dorsey, Mayor, Gerdy, &c. 

dessault's apparatus. 

Composition. — A splint, three inches wide, long 
enough to reach from the tuber ischii beyond the 
heel ; two, two and a half inch rollers eight yards 
long, a two inch band of the length of the limb, 
and some tow, &c. 

Application. — The thigh being bent on the 
pelvis, and the leg extended on the thigh, the limb 
is supported by an assistant. The long band is 
then placed on the front of the limb, and held by 
assistants in its place, until it is fixed by one of 
the rollers in an ordinary spiral bandage up to the 
knee. Two slits corresponding to the knee-pan, 
are then made in the band, to allow the fingers of 
the surgeon to pass through and bring down the 
upper fragment, when the roller is resumed, car- 
ried round the joint in several figures of 8, and 
then continued up the thigh, to compress its mus- 
cles and fix the end of the band. The use of this 
band is now seen to be, to fix the turns of the 
roller by preventing those of the leg from descend- 
ing, and those of the thigh from ascending. The 
limb being still elevated, the surgeon applies one 
end of the splint under the tuber ischii, and then 
filling up the inequalities of the limb with cotton 
or tow, extends it on the whole back of the leg, 
and confines it to the limb by simple spiral turns 
of the second roller. 
22 



254 MINOR SURGERY. 

This apparatus is very simple, but would per- 
haps answer as well without the band, as the rol- 
ler, if properly applied, will certainly not slip after 
the application of the splint. 

dorsey's apparatus. 

Composition. — A piece of wood, half an inch 
thick, three inches wide, and extending from the 
buttock to the heel. Near the middle of this splint 
two bands of strong muslin, about four inches 
wide, doubled on itself, and a yard long, are nailed 
at a distance of six inches apart. Two ordinary 
rollers, two small compresses, and some tow or 
soft flannel, complete the apparatus. 

Application. — An assistant raising the limb, as 
in Dessault's plan, the surgeon applies an ordinary 
spiral, to cover in the whole leg and foot, and on 
reaching the knee, brings the fragments as closely 
together as possible, and confines them by figure 
of 8 turns. He then covers in the thigh by the 
same sort of turns, places the splint properly pad- 
ded on the back of the limb, and fastens it by 
spiral turns of the second roller. On coming to 
the lower one of the transverse bands, it is to be 
passed above the upper fragment over the com- 
press placed there, and the upper strap passed 
below the lower fragment, and both secured by a 
pin or knot, when the remainder of the splint is 
to be covered in by the subsequent turns of the 
roller. 

This apparatus is the same in principle as Boy- 
er's, but has the advantage over it of being more 
simple, and easily obtained at a moment's notice, 
a shingle or strip of wood, a few tacks, and a piece 
of bandage, being all that is requisite. 



MINOR SURGERY. 



255 



MAYORS METHOD. 



This has been already mentioned under 
system, as the tarso-patellse handkerchief. 



his 



GERDYS PLAN, 



Is similar to the uniting bandage for transverse 
wounds. 

Application. — Place an ordinary spiral ban- 
dage on the leg and foot ; then lay the tailed band 
so that its ends may correspond with the lower 
fragment, and fasten it to the leg by a second 



Fig. 176. 




spiral firmly applied. Place a 
spiral bandage on the thigh, and 
laying the slit bandage so that its 
slits may correspond with the 
upper fragment, bind it by 
another spiral bandage, or by 
turns of the first also firmly 
to the thigh. Place the two 
compresses one above the 
upper fragment, the other be- 
low the lower fragment, and, 
passing the tails of one band 
through the slits of the other, 
press upon the compresses,and 
force the fragments into appo- 
sition, by fixing the lower one, 
and bringing the upper one to 
it. Then confide the ends of 
the bands to an assistant, and 
fasten them by another spiral 
of the lower extremity, begin- 
ning at the ankle and reaching 
to the groin, with figure of S 
turns at the knee over the whole. 



256 



MINOR SURGERY, 



AMESBURY S APPARATUS FOR THE SAME, 

Composition. — Two pads to be placed, one 
above and the other below the knee, each about 
five inches wide, and long enough to pass half- 
way round the limb: the pads are connected by- 
two short straps, and buckles ; — five straps, with 
buckles, to pass round the limb, three above and 
two below the knee, in order to fix them; — a 
long strap, to pass from the upper pad, to which 
it should be fastened, along one side of the leg 
and under the foot to meet a buckle attached to 
the same pad on the other side ; - — a properly- 
padded straight splint to extend along the thigh 
and leg ; — and lastly, a handkerchief, or a band 
about three-quarters of a yard long. 

Application. — A shoe is first to be applied upon 
the patient's foot, furnished at the sides with two 
small loops,//, and the leg extended upon the 
padded splint, e, after which the pads, a b, are 
placed above and below the knee, and secured, 
together with the splint, by means of the five 
straps mentioned above ; the fragments are then 

Fig. 177. 




to be brought into close contact by means of the 
short strap, c, and the long strap, d, which should 
pass through the loops of the shoe. The lower 



MINOR SURGERY. 



257 



part of the splint is maintained against the leg by 
means of the handkerchief or band. 



FRACTURES OF THE LEG. 



Fractures of one or both bones of the leg, with 
the exception of the lower end of the fibula, are 
with us usually treated in the same way. In these, 
as in other fractures, various means have been 
proposed, but as the most simple one has seldom 
or ever been known to fail, we shall confine our- 
selves to a description of it. 

HOSPITAL APPARATUS. 

This is Composed of an ordinary pillow, and a 
fracture-box. The fracture-box is made of four 
pieces of wood, the bottom one, extending from the 
knee to a little beyond the heel, has fastened to its 
lower end a perpendicular piece for the foot : to its' 
sides are fastened by hinges, two lateral pieces about 
seven inches wide, and intended to shut up against 
the sides of the limb and foot-board, to form the 
box. 



Fig. 178. 




Application. — Place the pillow in the box, the 
limb on the pillow, and, fastening the foot to the 

22* 



258 MINOR SURGERY. 

foot-board by a simple band over the instep, tie up 
the sides of the box, and the dressing is complete. 

If it is desirable to apply cold washes, or to 
protect the pillow from discharges, or if it is a com- 
pound fracture, a piece of oiled silk or coach cur- 
tain may be laid over it. 

This very simple apparatus is all that is used at 
the hospital for all fractures of the leg, except where, 
from great lateral inclination in fracture of the lower 
end of the fibula, Dupuytren's splint is necessary. 
But this is seldom the case, as the tying of the foot 
to the foot-board, so as to give it an inclination in- 
wards, and a little extra compression made at the 
internal malleolus by means of a pad of cotton, is 
all that is requisite. Attention must, however, be 
paid to the state of the heel, to see that it does 
not sink, and thus cause the lower fragment to 
project anteriorly ; and we must, also, see that the 
foot-board projects beyond the toes, to keep off 
the weight of the bed-clothes, and prevent their 
causing the same thing by the extension of the 
foot. The band across the instep prevents the 
foot's inclining to either side, and the pressure of 
the pillow against the limb by the sides of the 
box prevents lateral deviation. 

A simple rule, by which to tell whether a leg is 
properly set or not, is to see that the edge of the first 
joint of the big toe corresponds with the inner edge 
of the patella. This, even if the patient is bandy- 
legged, will generally keep us right as to the pro- 
per position of the limb. 

In this apparatus we have the parts constantly 
before us, can remedy instantly any deviation, 
and combat any inflammation by cold washes, &c. 

If the fracture is a slight compound one, attempts 



MINOR SURGERY. 259 

should be made to close the wound as soon as 
possible, and promote union by the first intention. 
To do this, draw it together with adhesive strips, 
and then apply over them a thick piece of patent 
lint, well wet with white of egg, so as to cause it 
to fit very closely to the limb, exclude the air, and 
form an artificial scab. This should not be re- 
moved for several days. If, however, the wound 
is a serious one, and proceeds to suppuration, 
nothing is equal to the plan of Dr. Barton. 

barton's bran dressing. 

Composition. — A fracture-box, some bran or 
fine saw-dust, and a little cotton. 

Application. — Fill the box, with its sides shut 
up, one-third full of bran, place the limb in this, 
fasten the foot to the foot-board as before, and stuff 
some cotton between the knee and the sides of the 
box, to keep the bran from escaping. Then fill 
up the box with bran, so as to cover in the wound 
and whole limb. This forms a very soft and 
equable bed for the limb, keeps the flies off from 
the wound, prevents the fetor from the discharges, 
and owing to its absorption of the blood or dis- 
charge at the wound, it swells, makes pressure on 
the part, and thus tends to arrest the hemorrhage, 
or prevent the formation of sinuses* After two 
or three days, if we wish to change it, scrape off 
the bran from the limb, and cleanse it from the 
wound by a spatula or syringe, and reapply it 
fresh. In hospitals, this dressing is especially use- 
ful, as it preserves the wards from the foetor of the 
discharges, which, without this, is sometimes almost 
insupportable. 

It also answers for extensive wounds of the leg 



260 MINOR SURGERY. 

or thigh, the box, in the latter case, being made to 
extend up to the trochanter of the femur. 

After the bony union in any case of fractured 
leg is tolerably firm, say after six weeks, an or- 
dinary spiral bandage may be applied, and over 
this two splints of binder's board, softened in hot 
water so as to mould themselves to the limb, and 
these may be confined there by another bandage, 
so as to strengthen the part before the patient at- 
tempts to walk about. 

Another method of treating fractures of the leg 
is by the recently revived method of Suetin, and 
Velpeau, or the Appareil Immobile. In the use 
of this apparatus, attention must be paid to the 
nature of the case, the constitution of the patient, 
&c. ; in other words, that it is a favourable case of 
simple fracture, without much contusion ; and it 
should also be recollected that the bandages used 
are to be ivashed rollers, applied as in the French 
spiral, so as to leave the heel and toes open to our 
inspection, as we may then judge of the state of 
the parts above. In applying.it, we must do it 
with a light hand, so that the bandages may not 
be too tight, and if the patient complains after its 
application, so as to show suffering, the whole 
must be removed. If thus applied, it serves a 
most excellent purpose, but is liable to abuse, 
without great attention on the part of the surgeon 
to its proper application. The manner of apply- 
ing it, and the result of the cases which were 
among the earliest in which it was tried in this 
country, will be best seen from the following re- 
port of those treated in the surgical wards of the 
Pennsylvania Hospital, in 1838. 



MINOR SURGERY. 261 

Case First. — Fracture of both bones of the leg — Applica- 
tion of the apparatus seven days after the accident — Cure 
without deformity. 

George R , set. 34 years, a shoemaker by- 
trade, and of temperate habits, was admitted into 
the Hospital, Dec. 25th, 1S38, with a fracture of 
the tibia, oblique at its lower third, and one of 
the fibula at its upper third, caused by a fall upon 
the ice. The limb at first was placed in the frac- 
ture-box, and evaporating lotions used to reduce 
the inflammation, which was considerable. On 
the third of January, seven days after the accident, 
the immoveable apparatus was applied in the 
following manner. A washed roller was smoothly 
applied, from the toes to the knee, cotton being 
placed along the spine of the tibia to prevent ex- 
coriation from the turns of the bandage, and also 
in the cavity, on each side of the tendo-Achilles, 
This was well rubbed over with starch, made 
thick and smooth by being boiled for twenty 
minutes. A second roller was then applied from 
the knee down and also well covered with starch. 
Two pieces of binders board cut to fit the sides of 
the leg and extend from below the knee to below 
the malleoli, were soaked in water until soft. 
They were then rubbed with starch, and applied to 
the leg over this, so as to surround the limb, except 
for the breadth of a finger on the front and back ; 
small cuts being made at the lower end to cause 
it to fit the projection of the malleoli, and also at 
any other point where it bulged out. A third 
splint, made to fit the foot, and slit at the end so as 
to enable it to turn up behind the heel, was then 
applied to the foot, starched and secured by a 



262 MINOR SURGERY. 

third roller from the toes up. This was coated in 
like manner — a fourth applied over all, and the 
dressing completed by starch, which kept the whole 
smooth and tight without the aid of pins. 

The limb was now laid carefully in an empty 
fracture-box, a little cotton placed under the heel, 
and the foot tied to the foot-board, where it was 
allowed to remain for four days, at the expiration 
of which period the whole was dry and hard, the 
limb being cased as firmly as in plaster. 

The patient was then allowed to remain in bed 
without any other dressing except the splints ; 
and on the ninth of January, thirteen days after 
the injury, a bandage was doubled around his 
neck, carried down behind the calf of the leg, 
then in front of the ankle, over the instep, and 
round under the foot to the instep again so as to 
form a sling and raise the foot a little from the 
ground, when he was allowed to walk about with 
crutches. In this way he continued until Febru- 
ary 7th, When the apparatus was taken off, before 
the class, the limb being perfectly straight and 
firm, and without the slightest deformity ; and on 
the 13th of February, seven weeks after the injury, 
the man was discharged. In this instance, the 
apparatus was not touched until the fourth week, 
when a simple roller was applied to tighten it, 
owing to looseness consequent on the shrinking of 
the muscles. One of the objections raised to the 
use of the apparatus was thus readily obviated 
without injury to the patient ; for, as the splints 
did not meet before and behind the leg, it was 
easy to fold the surplus bandage in, without caus- 
ing any welt on the skin, while the bandage, 
having been previously washed, shrunk but little. 



MINOR SURGERY. 263 

Case Second. — Fracture of the fibula two inches above the 
joint — Application of the apparatus seventeen days after 
the injury. — Cure without deformity. 

Patrick D , set. 42 years, a labourer, fell off 

a step on the 15th of January, and fractured his 
fibula obliquely, two inches above the external 
malleolus. Owing to the inflammation, leeches, 
and the antiphlogistic course, with the use of the 
fracture-box, were continued until February 1st, 
seventeen days after the accident, when the ap- 
paratus was applied as in the preceding case ; ex- 
cept that the splints were continued under the 
bottom of the foot, being slit up so that the fold 
under the foot did not interfere with the applica- 
tion of the splint to the sole, thus preventing all 
motion at the ankle-joint. After the apparatus 
had been dried in the fracture-box, with the foot 
well turned in, for five days, the patient Avas al- 
lowed to walk about, and on the 10th of Febru- 
ary, twenty-six days after the accident, he walked 
up to the third story of the house, and was ope- 
rated on by Dr. T. Harris for cataract. On Febru- 
ary 21st, the apparatus was removed — there being 
not the least deformity perceptible even to the 
touch, 

Case Third. — Oblique fracture of both bones of the leg — 
Application of the apparatus nine days after the accident — 
Cured. 

Patrick C , aet. 23 years, a labourer, whilst 

working on a rail-road on the ISth of January, 
was knocked down by the caving in of a bank 
of earth, and both bones of his leg broken ob- 
liquely, near the middle. He was treated in the 



264 MINOR SURGERY. 

usual way by the fracture-box, until the 27th of 
January, when the starch dressing was applied* 
January 31st, four days afterwards, was allowed 
to rise and walk, by degrees, more each day, 
until February 25th, thirty-eight days after the 
accident, when the apparatus was removed. The 
limb was perfectly straight without any motion 
between the bones, and strong enough to allow 
him to walk upon it. In this instance, the appa- 
ratus was not touched until the sixth day after its 
application, when on his complaining of its tight- 
ness over the instep, the foot was soaked for a few 
minutes in hot water, and, by introducing a spatula 
under the bandage, it was raised sufficiently to 
free the point of pain. Being then allowed to 
harden, he suffered no inconvenience afterwards. 
The next three cases were of fractures of the 
thigh, in which, as there was but the one bone to 
act on, and other objects to be considered than the 
mere apposition of the fractured ends, it was ap- 
plied at first, at a more advanced stage. 

Case Fourth. — Oblique fracture of the middle of the femur — 
Application of the apparatus fifty-three days after the acci- 
dent — Cure without deformity. 

Francis McG— , set. 22 years, of good habits, 
fell, on the 22d of November, down the hatchway 
of a vessel, and fractured his clavicle and femur. 
The clavicle was dressed with the usual apparatus, 
and the femur treated by the long fracture-box, 
fastened on the double-inclined plane, until Janu- 
ary 14th, fifty-three days after the injury, when 
the union not being firm, although there was con- 
siderable bony deposition, the apparatus was ap- 



MINOR SURGERY. 265 

plied as follows : — A roller was carried smoothly 
up from the toes to the groin, the limb being held 
up and extended by assistants; this was starched as 
in the first case, and covered by a second roller. 
A long splint of binder's board was then applied, 
from the tuberosity of the ischium to below the 
knee, on the back part of the thigh, and another 
from the groin to the patella, in front — so as to 
surround the limb entirely, except for the space 
mentioned in the dressings of the leg. These were 
then covered in the same manner as the splints in 
the first case, and a simple roller applied from the 
toes up to the lower part of the knee, so that it 
could be renewed at pleasure. The limb was then 
laid on a simple-inclined plane, until the appara- 
tus dried. Five days were necessary to dry it, 
when the man was allowed to walk about, the limb 
being supported by the sling before mentioned, and 
the splint behind preventing all flexion at the knee. 
On the 2d of February, about ten weeks after the 
accident, the apparatus was removed, without 
there being found any deformity or perceptible 
shortening in his gait, the measurement showing 
it to be a little more than a quarter of an inch 
less than the sound limb ; and on the 7th of Fe- 
bruary, the patient left the hospital. 

Cases Fifth and Sixth. — Oblique fracture of the upper third 
of the femur — Application of the apparatus thirty days after 
the injury — Perfect cure. 

Thomas H , aet. 26, a labourer, fractured 

his thigh at its upper third, December 6th, about 
fifty miles from town. He was dressed in the 
neighbourhood, and did not arrive at the hospital 
till the third day after the accident, owing to the 
23 



266 MINOR SURGERY, 

destruction of part of the rail-road. The limb was 
much inflamed and swollen, and was treated at 
first by the inclined fracture-box,* lotions, &c, until 
January 6th, when the starch apparatus was applied 
to it, and dried in the same manner as in the preced- 
ing case. On the 14th of January, the man was 
allowed to walk about, and the apparatus remained 
untouched, till its removal, February 12th, there 
being perfect union, and only one-eighth of an inch 
shortening by close measurement, and none per- 
ceptible in his gait; and on the 21st of February, 
eleven weeks after the injury, he was discharged. 

The same apparatus was applied to Patrick 

E , (who was admitted February 6th, with an 

oblique fracture, caused by blasting,) on tbfe 19th 
of February, thirteen days after the accident, and 
enabled him to sit up in bed five days afterwards, 
and on February 25th, to walk the length of the 
room. On his standing up, he feels too weak to 
walk readily, but has every prospect of doing so 
shortly. At present, he complains of no incon- 
venience from the dressing, and is able to turn 
about in his bed ; the limb being but little short- 
ened by measurement over the splints. The case 
got well, but with marked deformity, so much so 
as to make me resolve never again to apply it to 
the thigh before there was consolidation of the 
fracture. 

In the case of fractures of the leg, it enables the 
patient to move about in fifteen days, with perfect 
safety. It has not been deemed expedient to 
apply it so early as M. Velpeau has done, owing 
to the severe contusions which complicate most of 

* Chapman's double-inclined plane, with a fracture-box 
on it. 



MINOR SURGERY. 267 

the fractures received here ; but, with this restric- 
tion, it might, as far as the experience of these 
cases prove, be used in all simple fractures, as few 
will be found, in private practice, more severe than 
those on which it has been tried. In hospital 
practice, it promises to be of great utility, by 
doing away the risk of sloughs on the sacrum, 
from the constant pressure consequent on the long 
confinement on the back, and adds very materially 
to the patient's comfort, by allowing him to rise 
to a window, or to go from one apartment to 
another. In case second, it enabled a man to rise 
and undergo an operation for cataract, in a place 
where the light was better than in his own room.* 

Since then, I have seen it much used by M. Vel- 
peau, and do not hesitate to repeat the assurance 
of its utility to such cases of fracture of the leg as 
have been mentioned ; but I doubt the propriety 
of its use in fractures of the femur before there is 
consolidation. 

In very oblique fractures of both bones, exten- 
sion and counter-extension is sometimes necessary 
to prevent shortening. To obviate this, we should 
apply Physick's modification of Dessault's splints 
for fracture of the thigh, or Hutchinson's leg splints, 
though the first is preferable till the tendency to 
spasm of the muscles has gone off, when the usual 
means may be employed ; but we again repeat, 
that it is seldom any other dressing than the frac- 
ture-box is required. 

amesbury's apparatus for fractures of the leg. 

Composition. — A thigh-piece, properly shaped 
to receive the back of the thigh, having a pair of 

* Medical Examiner. 



268 MINOR SURGERY. 

lateral splints connected with it, and some studs 
for the retention of straps ; — a leg-piece, immove- 
ably connected to the thigh-piece at an angle, and 
hollowed out for the reception of the back of the 
leg; — a foot-piece, which maybe so shifted as 
to adapt the leg-piece to the length of the leg. 
The foot-piece should not rise higher than is neces- 
sary to form a right angle with the leg-piece when 
connected with it. There are some holes in each 
side of this, and a strap is attached to it, bearing 
upon one end a buckle ; a shoe, with a wooden 
sole, for the reception and retention of the foot, to 
which are attached two straps for connecting it 
with the foot-board. The shoe is supported by a 
foot-strap, which, when in use, extends from one 
side of the thigh-piece round the lower part of the 
foot-board, where it is passed under a strip of 
leather placed there to keep it in its place, and 
then carried up to the opposite side of the thigh- 
piece, where it is buckled. 

The apparatus ought to be first adapted to the 
sound limb in cases of simple fracture of the leg, and 
well padded ; a small concave pad, too, should be 
placed on the inside of the heel of the shoe, and 
another pad upon the sole. Two side splints are 
required, the outer one extending from the foot- 
board to the upper part of the outer condyle of 
the femur, and the inner one from the foot-board 
to the inner condyle; — also a split deal shin- 
splint ; and in cases of oblique fracture, a thin pad 
to be applied upon the instep, covered with a piece 
of paste-board, a little wetted, which, when dry, 
serves to equalize the pressure and keep the in- 
step easy. 

•Application. — In the first , or Inflammatory 



MINOR SURGERY. 



269 



stage. — The shoe, #, containing the heel and 
sole-pads, should be carefully placed upon the 
foot; the instep pad should then be placed upon 
the instep, and the shoe closed over it, and closely- 




confined to the foot by means of the buckles and 
straps attached to it for that purpose. An assist- 
ant should then place one hand under the knee, 
and, taking the foot in the other, raise the fractured 
limb, bringing it round so as to let it rest upon 
the heel. When the limb is raised, the surgeon 
places .the apparatus under it, and brings the ankle 
of the same opposite the bend of the knee, direct- 
ing the assistant to lower the limb upon it. 

The surgeon now fixes the shoe, a, to the foot- 
board, b, by means of the straps attached to the 
sole. By the aid of this shoe, he is enabled to 
raise or lower the foot according to the length of 
the heel or thickness of the calf, so as to bring the 
lower portion of the fractured bones into a proper 
line with the upper, as far as respects any angular 
projection backward or forward. A padded 
splint should be placed upon the front of the thigh, 
and the whole of the thigh-part of the apparatus 
23* 



210 MINOR SURGERY. 

fixed to the thigh by means of the straps, c. That 
done, the foot-board should be raised nearly to a 
right angle with the leg-piece, and fixed in this 
position by the foot-strap, d, care being taken that 
the heel does not bear against the sole of the shoe. 
The fractured ends should next be noticed ; and 
if the foot requires to be raised or lowered, it may 
be done by means of the strap which confines the 
shoe to the foot-board. 

The part of the pad, e, which lies under the 
small of the leg, should be raised and supported 
in close contact with it by means of tow placed 
between the pad and this part of the apparatus, 
so that the whole length of the back of the leg 
may have an equal bearing upon the apparatus. 

The lateral splints are next to be applied, the 
longest upon the outer side of the leg, and the 
shortest upon its inner side. The lower ends of 
these splints should be fastened to the foot-board 
by means of narrow tapes passed through the 
holes at the sides, and the upper end kept close to 
the leg by the circular strap, g-, passed round the 
limb over the splints and the apparatus. 

With respect to the position, the limb thus fixed 
should be placed with the apparatus resting upon 
the heel ; the two planes should be connected, as 
seen in the wood-cut, by means of the steel bar, 
which forms part of the apparatus for fractures of 
the thigh, and the whole steadied by tapes attached 
to the foot-board, and passing off from thence to 
the sides of the foot of the bed* Surgical appli- 
cations may be made by unbuckling the circular 
leg-strap, and throwing back the side splints. 

When the inflammation is subdued. — Some 
strips of soap-plaster, each about an inch and a 



MINOR SURGERY. 271 

half wide, should be applied with very moderate 
tightness round the limb, and sufficiently close ; 
they should pass from the ankle to a considerable 
distance above the fracture. The ends should be 
crossed on the sides or front of the leg, and cut 
off, so as to be easily turned back, when it is ne- 
cessary to observe the state of the skin. Some 
strips, or a short roller, should also be passed 
round the foot to prevent oedematous swelling in 
that part. When this is done, and the side splints 
re-applied, the shin-splint should be properly ad- 
justed, and the whole leg-part of the apparatus 
supported by three circular straps and buckles. 

The cross-bar may be now removed, and the 
apparatus furnished with a sling or thong of leather 
fixed to the lower end of the leg-part of the appa- 
ratus ; by means of this the limb may be moved 
passively at pleasure; the patient may recline upon 
a sofa, or rest his leg upon the seat of a chair. 
He may walk, too, with the assistance of crutches, 
passing in this case the sling over the neck, as in 
the ordinary way ; the movements of the limb, 
however, should be always passive, and never 
by the action of its own muscles. In a fortnight 
or three weeks' time, according to circumstances, 
the foot-board should be shifted a little higher up 
the leg-piece, to press the fractured ends together, 
and hasten their consolidation. 

Oblique Fractures. — In these cases extension 
must be made in the following manner: — the 
thigh-piece of the apparatus must first of all be 
pressed up closely against the back of the thigh, 
and the foot-board shifted down, so as to make 
the space between the foot-board and the thigh- 
piece longer than the leg ; an assistant then grasps 



272 



MINOR SURGERY. 



the foot and ankle in his hands, and makes gentle 
extension in the natural line of the bone, so as to 
bring the fractured parts into proper adaptation ; 
when this is done, the surgeon keeps up the ex- 
tension by buckling the strap, which is fixed trans- 
versely to the shoe, round the foot-board. Great 
care must be taken that the broken extremities 
unite in the relative position which they naturally 
occupy ; for this purpose auxiliary pads and rol- 
lers must be judiciously applied, according to the 
bone affected and the nature of the obliquity. 
The fullest particulars relating to this part of the 
treatment will be found in Mr. Amesbury's 
" Practical remarks on the Nature and Treatment 
of Fractures of the Trunk and Extremities." 

dupuytren's apparatus for fractures of the 
lower extremity of the fibula. 

Composition. — A wedge-shaped cushion, about 
two-thirds filled with bran or cotton, and of suffi- 
cient length to extend from the malleolus internus 
to the knee ; — a strong splint,about two feet long 
and three inches wide ; — and two single-headed 
rollers, from four to five yards long. 

Fig. 180. 




•Application. — As soon as the fracture is re- 
duced, the wedge-shaped cushion, e, with the base 



MINOR SURGERY. 273 

directed downward, is to be applied along the 
inner side of the leg; the splint, b, is next to be 
applied on this, and made to extend about four 
inches beyond the sole of the foot; these two por- 
tions of the apparatus should be confined to the 
limb, a, above by one of the rollers passed in cir- 
culars round it, c, from just below the knee to a 
short distance above the fracture, and below, by 
the second roller, or by the same one carried round 
the foot and instep in the form of a figure of 8, d. 
Care should be taken in applying this roller to draw 
the foot inward towards the splint, and maintain it 
firmly in the state of adduction, and the posterior 
part of the limb should repose, in a state of demi- 
flexion, upon pillows made to form an inclined 
plane. In the figure, the turns of the upper roller 
do not come far enough down, they should extend 
to within an inch or two of the fracture. 

APPARATUS FOR FRACTURE OF THE OS CALCIS. 

Composition. — A bit ofstrong roller,, two inches 
wide, and of sufficient length to extend from four 
inches beyond the foot to the lower third of the 
thigh ; — two single-headed rollers, eight yards long 
and two and a half inches wide ; — two graduated 
longitudinal compresses; — and a strong, well- 
padded, pasteboard splint, moulded to the fore- 
part of the foot and leg, and reaching from the 
roots of the toes to a certain distance above the 
knee. 

Application. — The foot and leg being held by 
an assistant, the first in the most complete exten- 
sion, and the second demi-flexed, another assist- 
ant should be requested to support the thigh, 
laying hold of it at its middle third. The surgeon 



274 MINOR SURGERY. 

then proceeds to apply a padding of lint or charpie 
over the toes, and extends the strip of roller from 
the instep along the sole of the foot, the back of 
the leg, and the lower and posterior part of the 
thigh, and the band being maintained thus by the 
assistants, the surgeon equalizes the posterior part 
of the ankle-joint, by means of the soft material, 
and applies the graduated compresses on each side 
of the tendo-Achillis. Next, taking one of the 
rollers, he fixes its initial end by a few circulars 
applied about the ankle, which secures, at the 
same time, this portion of the band, and reflects 
the remainder of the latter backward, and covers 
the whole of the foot. He now passes several 
figures of 8 about the heel, in order to embrace 
the separated portions of the bone, and maintain 
them in apposition, and then carries the roller to 
a short distance above the knee by a simple spiral 
bandage of the leg, and reflecting the upper part 
of the band downwards, fixes it by a few horizon- 
tal circulars just below the knee. In the last 
place, the padded splint is placed upon the fore- 
part of the limb and confined by the second roller, 
carried from the roots of the toes to the middle 
third of the thigh, and the limb is extended over a 
pillow, so as to form a double-inclined plane. 

In fractures of the metatarsal bones or of the 
toes, there is generally more occasion to combat 
the effects of injury to the soft parts than to set 
the fracture. We should, therefore, place the limb 
in a fracture-box, and elevate it to drain the blood 
from the part, apply cold washes, &c, and after- 
wards, if necessary, treat it as a fracture of the 
bones in the hand, though this will very rarely be 
necessary. 



MINOR SURGERY. 275 

Fracture-bridges, etc., are often spoken of, 
to keep the weight of the clothes off the foot, but 
nothing more is necessary than two halves of a 
common hoop tied together in their centres, as 
shown in the fracture of the thigh by Physick's 
plan. 



DISLOCATIONS. 

In the treatment of these injuries there is little 
that concerns us in a work of this kind. The 
causes, line of direction of the force causing the 
dislocation, and the lines of the extending and 
counter-extending forces, are so important, and 
would need so much space as to require almost 
a volume for themselves. Suffice it, then, for us to 
say, that the bands by which the extension is 
made, when considerable force is required, should 
always be fastened to the limb by means of a ivet 
circular, or spiral roller. To do this, soak an 
ordinary cylinder or single-headed roller hi water 
15 or 30 minutes before it is to be used, so that it 
may be well wet, and then having made a few 
circular or spiral turns around the limb, place the 
towel or other band on the point whence the ex- 
tension is to be made, and fasten it by other cir- 
cular turns of the same roller. The object of wet- 
ting the roller here, is merely to make it adhere 
more closely to the part, and prevent the extend- 
ing band from slipping. The counter-extending 
force is then to be applied by another towel or 
broad band placed at the desired point. After 
the bone is reduced, the limb is to be kept at per- 
fect rest for several weeks, by means of some of 
the bandages before mentioned, and which any 



276 MINOR SURGERY. 

one can now readily apply without the necessity 
of tedious repetition. Any one of the dressings 
here mentioned for fracture, is equally applicable 
to dislocations after their reduction, and we there- 
fore refer, for the details of this subject, to all the 
numerous works on Surgery. 



PART FOURTH. 

OF THE MINOR SURGICAL OPERATIONS. 

Under this head, we class all the operations of 
Surgery which do not require an extensive divi- 
sion of our tissues, and shall, consequently, here 
treat of the different kinds of bloodletting, of issues, 
setons, and moxas, injections, vaccination, and 
tooth-drawing. First — 

OF BLOODLETTING. 

By this term, we understand the use of every 
means of taking blood from the body, employed 
with a view of relieving or curing disease. These 
operations may, therefore, be divided into several 
kinds, according as they are practised upon the 
superficial veins by means of lancets, leeches, cups, 
&c, or upon the arteries. When the extraction of 
blood is made by a single opening, cut in one of 
the veins, it takes the name of Phlebotomy, or 
General Bloodletting; when from an artery, that of 
Arteriotomy ; and when done by the aid of leeches, 
or cups, it is especially designated as Local 
Bleeding. First -*- 



MINOR SURGERY. 277 



OF PHLEBOTOMY. 

This operation is practised upon the veins of 
various parts of the body, as at the bend of the 
arm, the back of the hand, the leg, or the neck, 
though the first is by far the most common. At 
the point where this is performed, we find gene- 
rally five veins arranged, so as to form a figure 
not unlike the letter M. These are, the Cephalic, 
the Basilic, the Median, and the Median Cephalic, 
and Median Basilic ; for the surgical anatomy of 
which, we must refer to other works, as a proper 
description of their relations would be too diffuse 
for a work like this. 

The easiest vein to bleed in at the bend of the 
arm, is the Median Basilic, but it is at the same 
time more dangerous than the Median Cephalic, 
on account of its position to' the artery, and to 
branches of the internal cutaneous nerve. Gene- 
rally, however, we take the fullest vein, provided 
the artery is not too near, and leave the nerves to 
chance. In thin persons the veins are more pro- 
minent and distinct than in fat ones, but they are 
also more likely to roll under the lancet ; whilst in 
fat people they are more firm, though less easily 
seen : we must, therefore, accustom ourselves to 
bleed by the touch, rather than the sight ; and to 
do this, practice our fingers on deep seated veins, 
or those in fat arms, till we can distinguish the 
elastic feel of a vein, from the tenseness of the 
tendon, or the pulsating cord of an artery. 

Operation. — Previous to bleeding at the bend 
of the arm, a simple circular bandage, or a liga- 
ture, should be placed, with moderate firmness, 
24 



278 MINOR SURGERY. 

just above the elbow, so as to arrest the circulation 
in the veins. It must not, however, be so tight as 
to arrest that in the arteries, as may be always told 
by placing the fingers on the pulse. After a cer- 
tain amount of friction to fill the veins, the fore- 
arm is either, held in an extended position by an 
assistant, or placed between the chest and the bend 
of the surgeon 3 ^ arm, or in his axilla, or the patient 
may rest his hand on the top of a stick. The sur- 
geon then feels under the vein, by making firm 
pressure on it, for the position of the artery, and 
if it is felt pulsating, should open the vein by a 
more horizontal cut than is usual, or choose another 
vein, or change the relative position of the vein 
and artery by strongly pronating the hand. He 
then places the thumb or fingers of his left hand 
• on the vein below the point at which it is to be 
opened, in order to steady it ; and holding the lancet 
in his right hand, and facing the patient, if he is 
bleeding in the right arm, or in the same hand, 
with his back to the patient if in the left arm, he 
cuts through the- integuments, and opens the an- 
terior parietes of the vein, still pressing on the 
vein, below the opening with the left hand. The 
basin or cup to hold the blood being previously 
placed, and the clothes around protected by a 
sheet, he then removes this hand from off the vein, 
and immediately the blood flies into the bowl. 
This is a neater plan than that of allowing the 
blood to escape immediately after the veiuisopened, 
as it protects the clothes or bed from the blood. 

The Lancets with which we bleed are of two 
kinds, viz. : the Spring and the Thumb Lancet ; 
and either is used, according to the views of the 



MINOR SURGERY. 



279 



operator or the wishes of the patient, there being 
no material advantage in the use of one rather 
than the other. 

If the Spring Lancet is preferred, it should be 
held between the forefinger and thumb of one 
hand, with its blade obliquely to the circumference 
and axis of the vein ; so that, on the spring being 




touched by the middle finger, the blade may be 
driven into the vein obliquely to its axis, and also 
a little on its side, as we are then less likely to 
wound subjacent parts. 

If, however, the Thumb Lancet is the one used, 
bend its blade to a right angle with the handle, 
and place it in the mouth, with the point of the 
blade turned from the hand that is to take it. Other- 
wise, when, after completing the preliminaries, 
we put the hand to the mouth to seize the instru- 
ment, we should be apt to injure ourselves by 
sticking its point into our own hands. 

In using this lancet, seize the blade between the 
thumb and forefinger of the hand that we prefer, 
and rest the third finger of the same hand on the 



280 MINOR SURGERY. 

arm as a point of support ; then placing the point 
of- the lancet on the vein, push it suddenly in- 
wards, upwards, and outwards, depressing the 
handle in a circle, so as to make a free incision in 
the line before spoken of; and having drawn the 

Fig. 182. 




amount desired, undo the ligature above the elbow, 
seize the skin aboutthe opening between thethumb 
and fingers, so as to close the wound, and wiping 
the arm clean from the blood, place a small com- 
press over the opening,confineit byadhesivestrips, 
or by a figure of 8 bandage of the elbow, as before 
spoken of, and place the patient in an easy posi- 
tion. Particular attention should be paid to the 
cleansing of the lancet after the operation, in order 
to prevent difficulty in our next call for its use, as a 
dirty lancet frequently causes abscesses of the part, 
gives rise to phlebitis, and endangers the life of the 
patient. If the opening in the skin and that in 
the vein do not correspond, a bloody tumour, called 
a Thrombus, will be formed from the blood escap- 
ing into the subcutaneous cellular substance. To 
remove this, enlarge the opening in the skin, and 
press upon the tumour ; or else leave it to be ab- 
sorbed by nature, assisted by moderate pressure. 



MINOR SURGERY. 



281 



In Bleeding in the Hand, the only rule is to 
open with a thumb-lancet that vein which is most 
easily seen ; these are generally the vena Salvatella, 
or the cephalic of the thumb: avoiding the tendons, 
and also guarding against a deep puncture for fear 
of injuring the parts beneath. 

Bleeding in the Jugular Vein is seldom prac- 
tised, on account of the danger of the introduction 
of air into the vein. When, however, it is deemed 
necessary, it should be done as follows : — 

Place a thick, graduated compress on the root 

Fig. 183. 




of \he vein just above the clavicle, and fix it by 
a narrow cravat, the ends of which should tie on 
the opposite axilla ; or else apply an oblique ban- 
24* 



282 MINOR SURGERY. 

dage of the neck and axilla, as before shown : or, 
we may compress the vein with the thumb ; though 
by this plan there is more danger of the entrance 
of air, as the compression is apt to be more imper- 
fect. If the vein does not become apparent from 
this compression, direct the patient to move the 
jaws as in mastication ; and when it is filled, open 
it with a thumb-lancet at its lower third, and place 
a bent card, or other substance likely to form a 
little trough, just below the opening, so as to carry 
the blood off to the receiver and prevent its trick- 
ling down the side of the patient. Having taken 
the amount desired, we close the orifice, as in the 
arm, by pressure of the thumb and forefinger, and 
fasten a compress over it by adhesive strips before 
removing the compression which filled the vein, 
as we thus ensure the non-entrance of air, which is 
very apt otherwise to prove almost instantly fatal* 

Bleeding at the Ankle is generally perform* 
ed in the internal saphena vein just above the 
malleolus, where it is very superficial, though it is 
also occasionally done on the foot itself, or on the 
external saphena vein. 

Operation. — In order to bleed here, we require 
the ligature, &c., as in the other cases, and also a 
bucket of warm water, in which to plunge the foot 
previous to the operation. The patient being 
seated, the limb is placed in the hot water as high 
as the calf, in order to assist the filling of the vein 
and render it more apparent. After some few 
minutes, it is then to be removed, the ligature 
applied about four inches above the malleolus, 
and the heel placed upon the point of the knee or 
on a low stool. A thumb-lancet being held in 



MINOR SURGERY. 



283 



the mouth,and the vein steadied as before shown, it 
is then seized by the hand 
which is most convenient, ^g- 184. 

and the vein opened by 
a wound, which should 
be rather longer than that 
made in the arm, in order 
to give a free discharge 
to the blood, which here 
seldom escapes in a jet ; 
it being more common to 
have to replace the limb 
in the warm water, in 
order to facilitate the flow 
of it, than to see the blood 
flow in a stream. The 
wound should not be 
allowed to sink into the 
water, but to remain just 
above it, and the amount 
of blood taken must be 

judged of by the discoloration of the liquid. When 
satisfied as to the proper quantity, it only remains 
to remove the ligature, wipe the limb, and confine 
a compress over the opening by the figure of 8 
bandage of the ankle. The only accident likely 
to result from bleeding at this point is, the wound- 
ing of the saphena nerve, the arteries being distant. 
Should the nerve be wounded, either in this or any 
of the other operations, it will be shown by pain, 
by twitchings, tingling, &c. To treatthis, we should 
apply a warm poultice, keep the limb at perfect 
rest for a couple of weeks,and use the antiphlogistic 
system generally. 

Bleeding is occasionally followed by irritation 




284 MINOR SURGERY. 

of the edges of the wound, by abscess, or by ery- 
sipelas. Any of these will be best combated by 
the use of the above means in the first stage, and 
such subsequent treatment as the knowledge of 
each practitioner will readily indicate. 

From want of proper attention in the selection 
of the vein, or from want of skill on the part of 
the operator, it occasionally happens that an artery 
is opened. This serious accident may be readily 
told by the brighter red colour of the blood, by its 
escaping in jets which are synchronous with the 
pulsations at the wrist, by the blood continuing 
to flow, notwithstanding firm compression of the 
vein below the opening, or by noticing the change 
in the colour of the blood produced by a very firm 
compression of the artery itself above the ligature. 
When thus satisfied of the nature of the accidejnt, 
we should endeavour to prevent our suspicions of 
it being seen by those around ; and if the state of 
health of the patient does not absolutely forbid 
it, let the blood flow till fainting is induced, when 
we should arrest it by a firmer compression 
than is requisite when the vein alone is opened. 
To do this, make, by means of several small gra- 
duated compresses, or by a thick pyramidal com- 
press, a cone, the point of which should rest upon 
the wounded vessel ; fix it by a firm figure of 8 
bandage of the elbow, and apply the Spiral of the 
Upper Extremity firmly, from the fingers up to the 
upper part of the limb. This treatment is to be 
continued for fifteen days or more, by which time 
the closure of the opening in the vessel is generally 
effected, when most probably an operation for 
aneurism will be required, though this is not abso- 
lutely certain, — Velpeau and others having seen 



MINOR SURGERY. 285 

cases in which the opening in the artery closed, 
without there having been at any time sufficient 
compression to stop the pulse at the wrist. Let it, 
however, be remembered that proper attention will 
enable us to avoid this serious accident, and that 
when it happens, it will be generally our own fault. 
Besides the veins here mentioned, bleeding was 
formerly practised in many others, as the occipital, 
auricular, frontal, sub-lingual, dorsalis-penis, &c, 
but the introduction of leeching has done away 
with the operations on these veins. Where, how- 
ever, leeches cannot be had, and it is desirable to 
take blood directly from the part, these veins may 
be opened by operating as in other veins. These 
operations are always performed by a thumb- 
lancet, the orifices in the external veins being 
afterwards closed by a compress and adhesive 
strips, &c. ; that in the sublingual, &c, by the ap- 
plication of cold, or salt and water, or astrin- 
gents, &c, 

ARTERIOTOMV. 

This operation, which was formerly practised 
by the surgeons of the sixteenth, seventeenth, and 
eighteenth centuries, and highly thought of by 
Hippocrates, Celsus, and Galen, has been almost 
entirely abandoned by those of our own times, no 
one now ever thinking of bleeding in the radial 
artery, or opening the lingual, or those of the mas- 
toid region, and very few of opening the tempo- 
ral. Should this, however, be deemed proper, and 
should there be no other way of drawing blood 
from the part to be benefited by the operation, 
the anterior branch of the temporal should be 
selected, and not the main trunk. 



286 MINOR SURGERY. 

Operation. — The patient being seated, with 
the head supported, or else laying down, we feel 
for the pulsation of the vessel, about fifteen lines 
in advance of, and above, the meatus auditorius 
externus, where the artery is almost without the 
temporal fascia, close under the skin, and well sup- 
ported by bone behind. Then, with a lancet or 
bistoury, we cut the vessel in half transversely, 
either by cutting from the skin inwards, or, what 
is better, from within outwards, as in Fig. 183, 
the instrument being previously introduced below 
the vessel. The artery should not be opened as the 
veins were, because the contraction of its muscular 
coat would tend to close the orifice, and stop the 
hemorrhage. As soon as the vessel is opened, the 
blood flies in a jet, and may be either received 
directly into a basin, or else drawn off by a bent card 
or trough, as in the operation on the jugular vein. 
Should the bleeding tend to stop before blood enough 
is taken, we should apply warm clothes to the part r 
wash out the clot, &c. ; but if enough has been 
taken, compress the artery below the puncture, 
close the wound, apply a compress, and fasten it 
either by a simple circular bandage of the vault of 
the cranium, or by the knotted bandage, as before 
seen. We repeat, however, that the operation in 
the present day can hardly or ever be necessary, 
whilst the subsequent effects, from the formation 
of aneurism, or the scar from the tying of the ves- 
sel, are disagreeable and troublesome. 

LOCAL BLOODLETTING. 

The name of local bleeding is generally given 
to that in which the smaller vessels and those 
close to the diseased part are opened* This is 



MINOR SURGERY. 287 

practised by means of leeches, cups, or scarifica- 
tions. 

LEECHING. 

The leech is an animal of the intervertebrated 
articulated family Annelidese, that has been em- 
ployed in medicine from almost time immemorial. 
This species, Hirudo Medicinalis, is an aquatic 
worm, with a flattened body tapering towards 
each end, and terminating in circular flattened 
disks, the hinder one being the larger of the two. 
It swims with an undulating motion, and moves 
when out of the water, by means of these disks or 
suckers, fastening itself first by one, and then by 
the other, and alternately stretching out and con- 
tracting its body. The mouth is placed in the cen- 
tre of the anterior disk, and is furnished with three 
cartilaginous, lens-shaped jaws, lined at their edges 
with fine, sharp teeth, which meet so as to make 
a triangular incision in the flesh. It varies from 
two to three or four inches in its length, and in- 
habits marshes and running streams in most of 
Europe, and many parts of the United States. 

Leeches afford the most effectual means of ab- 
stracting blood locally, as they are often applica- 
ble to parts which, from their situation or great 
tenderness, would not admit of the use of cups, 
and, in the case of infants, are always preferable 
to the latter. 

In order to readily apply them to a part, care 
should be taken to free it, by washing, from all 
medicaments, and by shaving, from all the hair 
or down on the skin. If the leech is very active 
or hungry, it will readily attach itself to the part 
when thus cleansed, but generally, it is necessary 



288 



MINOR SURGERY. 



to moisten the surface with a little blood, or with 
milk, or with sugar and water, when the leech 
will readily leave the vessel containing it, and 

Fig. 185. 




attach itself to the skin. If it is desirable to attach 
it to a certain point, place it in a large quill or glass 
tube, and put this directly on the part, when, as the 
animal cannot escape, it will readily attach itself. 
But when the part is not so circumscribed, it 
suffices to apply the edge of the cup, holding 
them just below the part, and let them crawl on 
to it, or place them under a tumbler, which 
confines their wandering, and causes them to 
attach themselves to the part beneath. 

Where blood is wanted to induce them to bite, 
it may be readily obtained by tying a string tightly 
round the extremity of the finger so as to render 
it turgid, and then lightly pricking it with a lancet ; 
the blood escapes in points, and may then be 
smeared on the part. This operation causes no pain, 
unless very often repeated on the same finger. 

Leeches, continue to draw blood until they are 



MINOR SURGERY. 289 

gorged, when they will drop off themselves ; but 
if it becomes necessary to remove them before 
they are thus filled, it should be done by washing 
them with a little salt and water, and not by pull- 
ing them off, as this is very apt to leave the teeth 
in the wound, besides being destructive to the 
leech. Six American leeches are calculated to 
draw one ounce of blood ; but as their bites fre- 
quently bleed as much as the animal itself drew, 
this is but an approximation of the quantity. 
Some persons are in the habit of cutting off the 
tail of the leech, in order to cause it to continue 
sucking for a long time, as the blood passes out 
as fast as swallowed ; but it is a barbarous practice, 
and of course destructive to the utility of the ani- 
mal. After the leech has come away, the bites 
continue to bleed, and this is often encouraged by 
the application of flannels, and cloths wrung out 
of hot water. But if we do not desire this extra 
amount of blood, cover their bites with a piece of 
linen moistened in sweet oil, or spread with fresh 
lard or cerate, to prevent its adherence to the 
wounds. Occasionally, it happens, in the case of 
children or weakly individuals, that the bleeding 
is profuse and debilitating. To arrest it under these 
circumstances, it is only necessary to touch each 
bite with a sharp-pointed piece of lunar caustic, 
which will arrest it almost immediately. A hot 
needle, stitches, &c, have been recommended, but 
the caustic is better, and more readily applied. 
In our large cities, where leeching is the peculiar 
business of a class of individuals, there is generally 
no difficulty in their employment ; but with the 
country practitioner it is different, as he must pre- 
25 



290 MINOR SURGERY. 

serve and apply them himself, and this is thought 
to be very troublesome. Let it, however, be 
recollected, that their application is sometimes 
a matter of absolute necessity, that, as above 
shown, it is simple, and two of the objections to 
their use are removed. Their preservation is 
then the only point of difficulty. The leech, 
when gorged, remain inactive or unfit for use for 
several weeks, and is also liable to disease, by 
which numbers are lost. All that is necessary to 
guard against this, is perfect rest in a vessel of 
fresh water ; in a few weeks they will again be fit 
for use. The preservation of them by the follow- 
ing rules is easy, and always ensures a supply. 
Never squeeze them to cause them to disgorge, it 
brings on disease ; but place them in clean water, 
and change it frequently ; a glass jar answers 
every purpose. Then, in order to keep them in 
health and ready for use, place them in a large tub 
or trough, six or seven inches deep, in a cool place, 
with a mixture of moss, turf, and fragments of 
wood at its bottom, with a few stones on this to 
keep it in its place. Place also, at one end, a 
piece of wood or earthenware filled with small 
holes and covered with a bed of moss, so that the 
leech may keep tip its natural habits, and by draw- 
ing itself through the holes in the board or through 
the moss, sticks or stones, free itself from the secre- 
tion of slime found on its body, which otherwise 
becomes the cause of disease. By changing the 
water occasionally, and keeping the trough or tub 
covered with a piece of muslin in a cellar, any 
practitioner can always have a supply of these 
useful animals at his command. Let it be always 
recollected, however, that those which have been 



MINOR SURGERY. 291 

used are to be kept separate from the others 
for about two months, when they may be replaced 
in the trough till again called for. If, in applying 
leeches to any point of the body whence they 
might escape to internal parts, as about the anus, 
the mouth, &c.,they should remain in these parts, 
they may be at once destroyed and ejected by the 
free use of salt and water, either as an emetic or 
enema. The fear, also, of any internal injury from 
them is groundless, as the heat and other pecu- 
liarities of the parts will at once destroy them. 

CUPPING. 

By the word cup, is understood a little bell-glass, 
four to six inches high, from which we exhaust 
the air, so that when applied on the skin it may 
cause a congestion and rising of this membrane 
from the pressure of the atmosphere upon the parts 
around the cup itself. These cups differ chiefly in 
the manner in which the air within them is ex- 
hausted, some being slightly open at the top, and 
fitted to receive the end of a small air-pump, 
others being entirely closed and exhausted by 
the use of fire applied internally in different ways. 
When the flesh is cut previous to the application 
of the cup, the blood will flow freely from the in- 
cisions, when the exhausted cup is placed over 
them, though it did not do so previously. This is 
termed cupping, or the application of ivet cups, in 
contradistinction to dry cupping, or that in which the 
cup isapplied merely to irritate the part without any 
scarification or drawingof blood. When we desire to 
exhaust a cup, it may be done either with the pump, 
by fitting it to the cup as prepared for it, applying 
the latter closely to the part, and then working the 



292 MINOR SURGERY. 

piston once or twice as in any ordinary pump, or by 
the use of fire to rarefy the air within the cup itself. 
With this view, various means are employed. 
It may be rarefied either by the rapid insertion of a 
candle or little torch, and the instant application of 
the cup to the part, or else the fire may be placed 
in the cup and it at once put on the skin. To do 
this, some shake a little alcohol around the inside 
of the cup, pour out what flows readily, andinflame 
the little that adheres to the glass by a lighted 
piece of paper ; others introduce small balls of in- 
flamed cotton saturated with alcohol, others simply 
use pieces of burning paper; but the two last cause 
unnecessary pain, by burning the skin on which 
they fall. The best and neatest way of exhausting 
the cup, is the following. Cut several pieces of 
letter-paper slightly glazed into strips about one 
inch and a half wide. Wrap this round the end 
of the forefinger, so that about one -third of its 
width shall project beyond the end of the finger, 
and having thus formed a little tube, tear off the 
rest of the strip and twist the part projecting beyond 
the finger, so as to close up the tube and form a 
little cap like a thimble. Dip the open end of this 
lightly into alcohol, a small portion will adhere to 
its glazed surface, touch it in a candle, throw it 
into the glass, and apply the latter at once to the 
part. The shape of the cone is such that it will 
nearly always fall on its apex, or the twisted end, 
whilst the part wet with the alcohol, or the base, 
will stand uppermost and sufficiently far from the 
skin to prevent its being burnt. Having by either 
of these modes exhausted the cup, we allow it to 
remain on the surface of the part till the portion 
under it has become turgid, when, if blood is to 



MINOR SURGERY. 293 

be taken, cut it by means of the scarificator, and 
reapply the cup as before, removing it when filled 
or half filled with blood, and reapplying it if ne- 
cessary. In order to remove the cup, introduce 
the nail of the forefinger under its edge, and gently 
force the cup on to its side, so as to allow the air 
to enter. After wet cupping, the parts are to be 
cleansed, and covered with cerate or an oiled rag. 
If the regular cupping apparatus, as furnished 
by the cutler's, is not at hand, we may perform the 
operation very well by using wine-glasses or 
tumblers, and scarify the parts if blood is to be 
taken by rapid punctures of a thumb-lancet, or a 
bistoury, or sharp penknife. 

SCARIFICATION, OR FLY-BITES. 

This is the name given to a number of light 
punctures, made by sticking a thumb-lancet into 
the skin in a great number of points, with a view 
of evacuating fluids beneath it, as in anasarca ; or 
of relieving inflammations or matter, as in erysi- 
pelas, abscesses under fasciae, or effusion of urine 
from rupture of the urethra. No other precaution 
is requisite than not to plunge the lancet deeper 
than the integuments, and to do it rapidly, in order 
to save the patient unnecessary pain. 

CUTANEOUS IRRITATIONS. 

Another useful means of depletion, is by means 
of the cutaneous exhalents, in the establishment of 
serous or suppurative discharges by frictions, 
blisters, setons, issues, and moxas. 

In Frictions, some irritating ointment or lini- 
ment is thoroughly rubbed on the part, either to 
25* 



294 MINOR SURGERY. 

redden it, or to produce serous discharges from 
blisters. 

In Blistering, the cutis is raised up by the ac- 
cumulation of serum produced by the application 
of Spanish flies, &c. ; after which the cutis is opened 
or cut away with sharp scissors, and the raw sur- 
face dressed by mild or stimulating ointments, ac- 
cording as it is desired to heal it up or keep it open. 

SETONS. 

A seton is one of the most powerful means of 
keeping up a cutaneous discharge. Strictly speak- 
ing, the seton itself is merely the band or substance 
employed to irritate the part, though the same 
name is given to the operation by which this band 
is introduced beneath the skin. Its seat is now 
very generally confined to the back of the neck, 
though it may be also applied to certain other 
parts, as the fleshy part of the thigh or arm ; but for 
these points, issues are more generally preferred. 

In order to apply a seton, we require a sharp 
cutting instrument to make an opening through the 
integuments, and some strip, which, when intro- 
duced, will, by its irritation, keep up a suppuration 
from the parts. For the insertion of it we have 
two instruments, Boyer's seton-needle, and a com- 
mon straight bistoury and eyed probe. 

The first consists of a flat steel blade, about five 
inches long, six lines wide, and perforated at one 
end with a hole large enough to receive the strip 
to be introduced ; the other end is sharp, and sloping 
to a point like a thumb-lancet. To introduce a 
seton with this, first fasten the substance to be used 
in the eye of the needle, and then seizing a portion 



MINOR SURGERY. 



295 



of the integuments of the required width between 
the forefinger and thumb of one hand, raise it up 
from the parts below, and transfix its base by- 
forcing the needle through, and drawing it and the 
seton out on the opposite side to that on which it 
entered, so as to leave the seton in the wound, 
after which its ends are to be fastened down to 
the part by a little piece of adhesive plaster, and 
the whole ^covered for the first three days by a 
warm poultice, till suppuration commences, when 
a simple dressing is all that is requisite. The ob- 
jections which we have to this method are, that the 
seton-needle is not always at hand, that the fast- 
ening of the seton in its eye makes a thick mass, 
which passes through the opening with difficulty, 
and that it is hard to hold the point of the needle, 
when wet with blood, so as to draw it through ; we 
much prefer the straight bistoury and eyed probe. 
To use this, fix the seton by a thread to the eyed 



Fig. 186. 




296 MINOR SURGERY. 

probe, seize the integuments as before, cut them 
with the bistoury, and before removing it, intro- 
duce the point of the probe from the opposite side, 
and withdrawing it and the bistoury at the same 
time, insert the seton in its place. 

In respect to the substance of the seton, there is 
much diversity of opinion, as has been already 
shown underthe head of dressings, Figure 24. But 
let the substance be what it will, it must always be 
well anointed with ointment previous to its in- 
troduction, in order to facilitate the entrance, and 
also previous to any movement of it through the 
wound in subsequent dressings. For the first 
three days the poultice is stained by blood, or slight 
oozings, but afterwards by pus. When suppura- 
tion has freely commenced, the substance of the 
seton becomes charged with matter, which, if 
allowed to remain, becomes very offensive. At 
each daily dressing, therefore, the seton is to be 
drawn through the wound till this soiled part is 
free, when it is to be cut off, and the ends fastened 
down and dressed as before with simple dressings, 
confined by a circular bandage of the neck, as at 
Fig. 34, or by a sling, as at Fig. 92. As the seton 
by this operation is soon cut up, it will be neces- 
sary to prepare for the introduction of a new one. 
This is readily accomplished by attaching it by a 
few stitches to the old one, anointing it well, and 
drawing this into its place as the old one is re^ 
moved. A skein of saddler's silk, or a piece of 
silk braid, is the kind most frequently employed, 
but where we can obtain a strip of gum-elastic, or 
a braid or tape coated with it, it will be found to 
be much more cleanly than the former. For the 
cases requiring the use of the seton, and for the 



MINOR SURGERY. 297 

period of its duration, we must refer to other 
works. 

ISSUES, 

Are intended to relieve different portions of the 
system, either by acting as drains, and thus deple- 
ting, or as counter-irritants, where a long-continued 
inflammation is desired, as in the treatment of 
caries of the spine, neuralgia, chronic insanity, &c. 

Issues are made in two ways : either by the de- 
struction of the integuments from the action of a 
powerful caustic, or by incising them and prevent- 
ing their subsequent union. 

To make an issue by the first means, lay upon 
the part a piece of diachylon plaster, or kid spread 
with soap cerate, and having in its centre a hole 
of the size desired for the issue, generally about 
two lines in diameter. Rub the integuments with- 
in this hole with a piece of caustic potassa, 
till they become black, and repeat the opera- 
tion each day till we attain an eschar of the de- 
sired depth, generally not deeper than the inte- 
guments. Or, place in the hole in the plaster, 
a piece of potassa of the size of a hemp-seed, 
and cover the whole with another piece of plaster, 
a small compress, and a bandage. After twelve 
hours remove these, and apply a small warm poultice 
to hasten the separation of the slough. When the 
slough come away, we have a deep circular ulcer, 
which is to be filled by three or four peas made 
of Orris, or some other porous root, and dressed 
with cerate, or basilicon, or mezereon ointment, 
according to circumstances. The subsequent 



298 MINOR SURGERY. 

dressing, usually daily, will also depend on cir- 
cumstances ; fungous granulations are to be re- 
moved by caustic, suppuration kept up by mov- 
ing the peas, or, if it is desired to heal it up, 
by removing them and using simple dressings. 
Issues may be made in any part of the body, pro- 
vided there is sufficient depth of cellular substance 
below to keep up a free discharge, and no joint, 
vessel or bony surface sufficiently near to be in- 
jured by the caustic. Washing the part with 
vinegar will at any time stop the action of the 
potassa. If nitrate of silver is used, wash with 
salt and water ; and if sulphuric acid, with mag- 
nesia, or some other alkali. 

MOXA. 

This is the name given to little rolls of inflam- 
mable matter, which are intended to cause eschars 
and subsequent issues, by being allowed to burn 
upon the integuments until they cause its destruc- 
tion. These are made of various substances, as 
cotton, lint, tow, &c, soaked in a saturated solution 
of nitre, dried and then wrapped up in little bags ; 
or, rolls of silk, or muslin, sewed together at the 
sides, or formed into rolls and coated with gum ; 
or we may use the common punk, as found in 
sticks in the tobacconists, cut into pieces about 
one inch long. The application of any of these 
cylinders is very simple. Having chosen a spot 
where the subjacent parts of importance are not 
likely to be injured by the extension of the inflam- 
mation, place upon it a piece of moistened cloth, 
with a hole in its centre large enough to receive 



MINOR SURGERY. 



299 



the moxa. This cloth is intended to preserve the 
surrounding parts from the sparks which some- 
times escape. Next see that the end of the moxa 
is applied to the body flatly, so that it may fit 
itself accurately to the surface, and moisten it with 
a little gum to make it adhere ; or else hold it firmly 
on the part, by a pair of forceps, or a porte-moxa 
or metallic ring, as in the figure. Having now 
lighted one end of the cylinder, keep up the com- 
bustion by the breath or a pair of bellows ; the 

Fig. 187. 




latter is necessary where its smoke irritates the 
bronchia too much. In its burning, the patient 
first feels a gentle heat, which gradually increases 
until, as the fire approaches the part, the pain for 



300 



MINOR SURGERY. 



the moment becomes excruciating, and destroys 
entirely the vitality of the part. The eschar thus 
formed is then treated like the eschar formed by 
the caustic in the issue, and the subsequent treat- 
ment will be also similar, to what has been there 
said. 



VACCINATION. 

The introduction of the vaccine is to be accom- 
plished by a slight puncture with a thumb- lancet 
through the cutis only ; or by removing the cutis by 
a blister, and rubbing it on the denuded surface ; 

or by making four or six 
Fig. 188. incisions with a lancet 

through the cuticle, cross- 
ing these by other lines, 
and introducing the mat- 
ter under the angular 
points of skin thus made, 
and letting it dry before the 
clothes can rub it. The 
latter should be kept from 
irritating the sore through- 
out the treatment. The 
figure shows the appear- 
ance three days after the 
puncture ; the appearance 
of the scab at the seventh 
day, at the. eighth, ninth, 
eleventh, and twelfth, but, 
of course, imperfectly, it 
being impossible to do more 
here than hint at the ap- 
pearances. 












" ; 




MINOR SURGERY. 



301 



INJECTIONS. 

These are practised upon various parts of the 
body, as in the Lachrymal Ducts, the Rectum, the 
Urethra, and the Vagina. For the first we require 
an Annesly's syringe, and such a knowledge of the 
part as may be best gained from the various works 
on the eye. Enemata, or injections into the rec- 
tum, are more common, and though generally 
performed by the attendants, yet often fall to the 
lot of the young practitioner either to direct or to 
perform. In order to give one without causing 
pain, especially if a patient have hemorrhoids, oil 
the forefinger of the left hand and introduce it 
within the sphincter ani,and passing the oiled end 

Fig. 189. 




of the syringe along this as a director, carry its 
point in the line of the curve of the sacrum. In- 
jections into the urethra are most frequently prac- 
26 



302 MINOR SURGERY. 

tised by the patients themselves, l)ut few, if any, 
do them properly. . As much of their success de- 
pends on this, special directions should always be 
given. Let them, therefore, be told, to proceed 
thus : Fill the syringe, and insert its end gently 
within the urethra, closing the orifice around its 
point, as in Fig. 189. Then sitting down on the 
edge of a chair or bed, or upon a ball made by rol- 
ling up a handkerchief, so as to press on the peri- 
neum, throw the fluid in by a motion of the piston, 
as in the figure, and withdrawing the instrument, 
close the urethra, and hold the injection for a few 
minutes. In injections into the vagina, let the pa- 
tient lay down on the back with the hips raised 
by a pillow, use a female syringe, and retain the 
fluid by cloths, &c, as long as possible. 



TOOTH-DRAWING. 

The surgeon is occasionally called on to extract 
teeth, in the performance of operations on the jaws, 
or in country-towns, &c, where there are no regu- 
lar dentists, but, except under such circumstances, 
it should be avoided, it being generally considered 
as derogatory to his higher and more important 
position. We, therefore, shall be very brief in our 
remarks on this subject. The simplest method of 
extracting any of the teeth, except the incisors, is 
by the use of the key. To operate with this, lance 
the gum thoroughly all round the tooth, to free it 
from its adhesions ; and having surrounded the 
fulcrum of the key with a few turns of a roller, 
to prevent its injuring the soft parts, place it 



MINOR SURGERY, 303 

on the inside of the tooth that is to be drawn, a 
little below the level of the alveolar process, and 
fix the claw on the outside of the crown of 
the tooth, where the gum joins it. Then grasping 
the handle of the instrument firmly in the hand, 
rotate it slightly to fix the claw on the tooth, and 
then by a quick movement of the wrist in rotation 
turn the tooth out of the socket. Sometimes the 
claw alone extracts it, but frequently, it merely 
bends it over, and we have to extract it by a 
slight rotatory and drawing movement of the 
forceps, drawing it upwards and inwards in the 
line of insertion of the tooth. For the extraction 
of the incisors, lance the gum as before, and seizing 
the tooth in the forceps, pull downwards, or up- 
wards and inwards, varying with the upper or 
lower jaw, giving also a slight movement of rota- 
tion. We must take care not to close the forceps 
too firmly on the tooth, as this will sometimes cut 
the tooth short off at the gum, leaving a stump in 
the socket. 

There are many other duties which fall upon 
the young surgeon, but they are generally in- 
cluded in a course of lectures on surgery, and as 
they would enlarge our pages beyond proper 
limits, we are compelled to pass them by. 



THE END. 



3477 



